Provider Demographics
NPI:1861720336
Name:MATTHIAS, TONJA (DC)
Entity type:Individual
Prefix:DR
First Name:TONJA
Middle Name:
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MCCLURE AVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3574
Mailing Address - Country:US
Mailing Address - Phone:314-750-7361
Mailing Address - Fax:636-600-0670
Practice Address - Street 1:558 GRAVOIS RD STE 201
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4153
Practice Address - Country:US
Practice Address - Phone:314-574-1907
Practice Address - Fax:636-600-0670
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor