Healthcare Provider Details

I. General information

NPI: 1912005653
Provider Name (Legal Business Name): STEPHEN JOHN MATLAGA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 OXMEAD RD
BURLINGTON NJ
08016-4215
US

IV. Provider business mailing address

1603 OXMEAD RD
BURLINGTON NJ
08016-4215
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-6100
  • Fax: 609-386-2838
Mailing address:
  • Phone: 609-386-6100
  • Fax: 609-386-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00120400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: