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General NPI Number Information
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NPI Number | 1871839720
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Entity Type | Organization
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Legal Business Name | MATHEWS FAMILY CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 126 WEST 6TH STREET
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City | IMPERIAL
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State | NE
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Zip | 69033-0404
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Country | US
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Telephone | 308-423-5626
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Fax | 308-423-5625
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | BENKELMAN
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State | NE
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Zip | 69021-0583
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Country | US
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Telephone | 308-423-5626
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Fax | 308-423-5625
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON ERIC MATHEWS
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Credential | D.C.
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Telephone | 308-423-5626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1237
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License Number State | NE
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