Individual
JAMES C MATTERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, PC
Contact information
Practice address
1231 CUMBERLAND AVE #D, WEST LAFAYETTE, IN 47906-1358
(765) 463-7337
(765) 497-4393
Mailing address
1231 CUMBERLAND AVE #D, WEST LAFAYETTE, IN 47906-1358
(765) 463-7337
(765) 497-4393
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001204A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092081
ANTHEM
IN
01
—
00630
ANTHEM MEDICAID
IN
01
—
08001204A
STATE LICENSE
IN
05
—
100232700A
—
IN
01
—
350048296
RAILROAD MEDICARE
IN
01
—
352009282001
ANTHEM EIN W/SUFFIX
IN
01
—
352009282100
CARESOURCE MEDICAID MCP
IN
Enumeration date
01/16/2008
Last updated
01/16/2008
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