Individual
MR. IAN DANIEL MATLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 E NORMAL AVE, KIRKSVILLE, MO 63501-4200
(816) 244-7674
Mailing address
2903 ANGELIQUE ST, SAINT JOSEPH, MO 64501-3436
(816) 244-7674
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/31/2023
Last updated
05/15/2024
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