Provider Demographics
NPI:1861588733
Name:MATHES, MICHAEL PHILIP (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:MATHES
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 1:9129 DICKEY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2502
Mailing Address - Country:US
Mailing Address - Phone:804-746-5700
Mailing Address - Fax:804-746-0500
Practice Address - Street 1:9129 DICKEY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2502
Practice Address - Country:US
Practice Address - Phone:804-746-5700
Practice Address - Fax:804-746-0500
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA171936OtherBC/BS
VAC06302OtherBC/BS GROUP #
VA161625891Medicare UPIN
VA350001055Medicare ID - Type Unspecified
VAC06302OtherBC/BS GROUP #