Provider Demographics
NPI:1548332810
Name:MATEO, DOUGLAS JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:MATEO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 MAIN ST
Mailing Address - Street 2:POBOX 530
Mailing Address - City:EUDORA
Mailing Address - State:KS
Mailing Address - Zip Code:66025-9471
Mailing Address - Country:US
Mailing Address - Phone:785-542-5400
Mailing Address - Fax:785-542-5402
Practice Address - Street 1:707 MAIN ST
Practice Address - Street 2:BOX 530
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025-9471
Practice Address - Country:US
Practice Address - Phone:785-542-5400
Practice Address - Fax:785-542-5402
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor