Individual
DR. MATTHEW BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
204 LEGACY PLZ W, LA PORTE, IN 46350-5285
(219) 476-7246
(219) 476-1713
Mailing address
219 E IRELAND RD, SOUTH BEND, IN 46614-2653
(574) 291-1000
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002885A
IN
Other
Enumeration date
01/27/2016
Last updated
01/13/2018
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