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General NPI Number Information
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NPI Number | 1265846653
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Entity Type | Organization
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Legal Business Name | LANSING PAIN AND REHAB PLLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 1717 E MICHIGAN AVE SUITE A
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City | LANSING
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State | MI
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Zip | 48912-2840
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Country | US
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Telephone | 517-253-8360
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 E MICHIGAN AVE SUITE A
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City | LANSING
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State | MI
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Zip | 48912-2840
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Country | US
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Telephone | 517-253-8360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY LEE MATFUS
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Credential | M.D.
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Telephone | 201-294-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009983
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301105023
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501009083
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License Number State | MI
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