Healthcare Provider Details

I. General information

NPI: 1811955925
Provider Name (Legal Business Name): G. MATT HOWARD III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W WHITE RIVER BLVD
MUNCIE IN
47303-3868
US

IV. Provider business mailing address

808 W WHITE RIVER BLVD
MUNCIE IN
47303-3868
US

V. Phone/Fax

Practice location:
  • Phone: 765-254-9481
  • Fax: 765-254-9493
Mailing address:
  • Phone: 765-254-9481
  • Fax: 765-254-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000546A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: