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General NPI Number Information
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NPI Number | 1942565064
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Entity Type | Individual
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Provider Name | MATTHEW R DRAKE D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/15/2017
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Provider Practice Location Address
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Address Line | 22575 TONGANOXIE RD
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City | TONGANOXIE
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State | KS
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Zip | 66086-4229
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Country | US
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Telephone | 913-708-0867
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 N 155TH ST STE C
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City | BASEHOR
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State | KS
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Zip | 66007-7100
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Country | US
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Telephone | 913-708-0867
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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 | 0105479
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License Number State | KS
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