MEDICARE: DR. LUKE MATTISON 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	32416	CA

General Provider Information

NPI Number	:	1316372147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKE MATTISON D.C.

Provider Business Mailing Address
First Line	:	600 E MAGNOLIA BLVD
Second Line	:	APT. #306
City	:	BURBANK
State	:	CA
Zip	:	91501-3601
Country	:	US
Telephone Number	:	818-433-1404
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3324
Country	:	US
Telephone Number	:	310-838-1600
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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Directions to “ DR. LUKE MATTISON D.C.” Practice Location

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