Provider Demographics
NPI:1366551467
Name:MATURY, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:MATURY
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 1:400 13TH AVE S
Mailing Address - Street 2:STE 104
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4300
Mailing Address - Country:US
Mailing Address - Phone:406-727-1660
Mailing Address - Fax:406-452-9094
Practice Address - Street 1:400 13TH AVE S
Practice Address - Street 2:STE 104
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4300
Practice Address - Country:US
Practice Address - Phone:406-727-1660
Practice Address - Fax:406-452-9094
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMSF1264037OtherSTATE FUND
000041203OtherBLUE CROSS
U14033Medicare UPIN
000041203OtherBLUE CROSS