Healthcare Provider Details

I. General information

NPI: 1184637878
Provider Name (Legal Business Name): MATTHEW MICHAEL TRUE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 EAST STEVE WARINER DR
RUSSELL SPRINGS KY
42642
US

IV. Provider business mailing address

262 EAST STEVE WARINER DR
RUSSELL SPRINGS KY
42642
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-7246
  • Fax: 270-866-7266
Mailing address:
  • Phone: 270-866-7246
  • Fax: 270-866-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4917
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4917
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: