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General NPI Number Information
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NPI Number | 1558356329
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Entity Type | Organization
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Legal Business Name | MATTHEW R. GAGE, D.C.,P.A.
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 1701 E MADISON AVE STE A
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City | DERBY
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State | KS
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Zip | 67037-3000
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Country | US
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Telephone | 316-788-3713
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Fax | 316-788-3231
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Provider Business Mailing Address
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Address Line | 1701 E MADISON AVE STE A
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City | DERBY
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State | KS
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Zip | 67037-3000
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Country | US
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Telephone | 316-788-3713
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Fax | 316-788-3231
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW R. GAGE
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Credential |
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Telephone | 316-788-3713
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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 | 01-033389
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License Number State | KS
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