Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 03838 | MD |
N | 111NR0400X | Rehabilitation Chiropractor | 0104002090 | VA |
Y | 111NR0400X | Rehabilitation Chiropractor | 03838 | MD |
NPI | 1235207465 |
---|---|
Provider Name | Dr. James Patrick Matchett |
First Address | Berlin, MD 21811 |
Second Address | Salisbury, MD 21801-4103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 30/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
383782 | ANTHEM PROVIDER NUMBER (01) | VA |