Provider Demographics
NPI:1942293345
Name:JOHNS, MATTHEW L (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:JOHNS
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 1:1113 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-2217
Mailing Address - Country:US
Mailing Address - Phone:414-687-2273
Mailing Address - Fax:
Practice Address - Street 1:5504 ASHWORTH RD
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7100
Practice Address - Country:US
Practice Address - Phone:515-225-4002
Practice Address - Fax:888-550-7916
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2547-012111N00000X
IA124592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35466Medicare ID - Type Unspecified
U11455Medicare UPIN