Healthcare Provider Details

I. General information

NPI: 1841455367
Provider Name (Legal Business Name): RYAN K. VAN MATRE, DC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR SUITE 211
CARMEL IN
46032-5877
US

IV. Provider business mailing address

755 W CARMEL DR SUITE 211
CARMEL IN
46032-5877
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-9900
  • Fax: 317-817-9903
Mailing address:
  • Phone: 317-817-9900
  • Fax: 317-817-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number08001984A
License Number StateIN

VIII. Authorized Official

Name: DR. RYAN KARL VAN MATRE
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 317-817-9900