Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 38MC00768000 | NJ |
NPI | 1245860147 |
---|---|
Provider Name | Matthew Chletsos |
First Address | Lavallette, NJ 08735-1615 |
Second Address | Freehold, NJ 07728-2547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2020 |
Last Update Date | 20/01/2020 |