Healthcare Provider Details

I. General information

NPI: 1356565444
Provider Name (Legal Business Name): MATHENY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 108TH AVE NE
BELLEVUE WA
98004-5578
US

IV. Provider business mailing address

555 108TH AVE NE
BELLEVUE WA
98004-5578
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00021246
License Number StateWA

VIII. Authorized Official

Name: DR. JEFFREY L MATHENY
Title or Position: CHIROPRACTIC
Credential: D.C
Phone: 425-452-9280