MEDICARE: DR. ROBERT EDWARD MATTS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5232	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P100015199	OTHER	KY	MEDICARE PTAN GROUP
5	P400015200	OTHER	KY	MEDICARE PTAN INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	50031233	OTHER	KY	PASSPORT GROUP ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50031234	OTHER	KY	PASSPORT INDIVIDUAL ID NUMBER

General Provider Information

NPI Number	:	1043534977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD MATTS D.C.

Provider Business Mailing Address
First Line	:	12935 W HIGHWAY 42
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-9107
Country	:	US
Telephone Number	:	502-228-5552
Fax Number	:	502-228-5542

Provider Business Practice Location Address
First Line	:	12935 W HIGHWAY 42
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-9107
Country	:	US
Telephone Number	:	502-228-5552
Fax Number	:	502-228-5542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	09/15/2025

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Directions to “ DR. ROBERT EDWARD MATTS D.C.” Practice Location

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