Provider Demographics
NPI:1043726615
Name:MATTHEW WALDRON DC
Entity type:Organization
Organization Name:MATTHEW WALDRON DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-778-9600
Mailing Address - Street 1:23009 56TH AVE W STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4713
Mailing Address - Country:US
Mailing Address - Phone:425-778-9600
Mailing Address - Fax:425-332-7018
Practice Address - Street 1:23009 56TH AVE W STE B
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4713
Practice Address - Country:US
Practice Address - Phone:425-778-9600
Practice Address - Fax:425-332-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110587OtherWA L&I