MEDICARE: MATTHEW LANE HARBOUR 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	984	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942678206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LANE HARBOUR D.C.

Provider Business Mailing Address
First Line	:	332 E MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1508
Country	:	US
Telephone Number	:	304-948-5979
Fax Number	:	681-233-0001

Provider Business Practice Location Address
First Line	:	332 E MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1508
Country	:	US
Telephone Number	:	304-948-5979
Fax Number	:	681-233-0001

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

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	02/22/2018

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