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General NPI Number Information
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NPI Number | 1407685357
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Entity Type | Individual
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Provider Name | HENRY CARL MATTHES IV DC
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Gender | Male
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 311 N MAIN ST
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City | NORTH BALTIMORE
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State | OH
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Zip | 45872-1136
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Country | US
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Telephone | 419-601-5103
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 WINGSTON RD
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City | NORTH BALTIMORE
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State | OH
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Zip | 45872-9454
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Country | US
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Telephone | 419-601-5103
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC-05371
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License Number State | OH
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