Healthcare Provider Details

I. General information

NPI: 1609916352
Provider Name (Legal Business Name): JEFFREY LEE MATHENY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 108TH AVE NE SUITE 1
BELLEVUE WA
98004-5578
US

IV. Provider business mailing address

14015 SE SOMERSET BLVD
BELLEVUE WA
98006-2326
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-9280
  • Fax: 425-452-9306
Mailing address:
  • Phone: 425-614-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003438
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: