MEDICARE: DR MATTS OFFICE LTD

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

General Provider Information

NPI Number	:	1790442754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MATTS OFFICE LTD

Provider Business Mailing Address
First Line	:	111 N STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2217
Country	:	US
Telephone Number	:	815-568-9900
Fax Number	:	815-568-9901

Provider Business Practice Location Address
First Line	:	111 N STATE ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-2217
Country	:	US
Telephone Number	:	815-568-9900
Fax Number	:	815-568-9901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW BANKORD
Credential	:	DC
Telephone Number	:	815-568-9900

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	11/24/2021

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Directions to “DR MATTS OFFICE LTD ” Practice Location

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