Healthcare Provider Details

I. General information

NPI: 1104031780
Provider Name (Legal Business Name): MATHEWS FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CHIEF ST
BENKELMAN NE
69021-3065
US

IV. Provider business mailing address

503 CHIEF ST
BENKELMAN NE
69021-3065
US

V. Phone/Fax

Practice location:
  • Phone: 308-423-5626
  • Fax: 855-513-0677
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1237
License Number StateNE

VIII. Authorized Official

Name: DR. JASON MATHEWS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 308-423-5626