Provider Demographics
NPI:1043534977
Name:MATTS, ROBERT EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MATTS
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 1:9217 US HIGHWAY 42
Mailing Address - Street 2:STE A
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8854
Mailing Address - Country:US
Mailing Address - Phone:502-228-5552
Mailing Address - Fax:502-228-5542
Practice Address - Street 1:9217 US HIGHWAY 42 STE A
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8854
Practice Address - Country:US
Practice Address - Phone:502-228-5552
Practice Address - Fax:502-228-5542
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP100015199OtherMEDICARE PTAN GROUP
KY50031233OtherPASSPORT GROUP ID
KY7100137280Medicaid
KY50031234OtherPASSPORT INDIVIDUAL ID NUMBER
KYP400015200OtherMEDICARE PTAN INDIVIDUAL