Healthcare Provider Details

I. General information

NPI: 1104977313
Provider Name (Legal Business Name): MATTHEW JAMES BARTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 LEONARD ST NE
GRAND RAPIDS MI
49503-1234
US

IV. Provider business mailing address

1122 LEONARD ST NE
GRAND RAPIDS MI
49503-1234
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-8552
  • Fax: 616-459-8562
Mailing address:
  • Phone: 616-459-8552
  • Fax: 616-459-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007668
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: