Active NPI
Kathryn Nichole Matlack, DC
- Chiropractor
- Newport Beach, CA
National Provider Identifier
1245948645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 36439
- Practice address
- 20201 SW Birch St Ste 100
Newport Beach, CA 92660-1781 - Phone
- (949) 259-5054
- NPI assigned
- Nov 14, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 36439 | CA | Primary |
Addresses
Primary practice location
20201 SW Birch St Ste 100
Newport Beach, CA 92660-1781
Mailing address
5522 Laurelton Ave
Garden Grove, CA 92845-1540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36439 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1245948645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5522 LAURELTON AVE",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928451540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20201 SW BIRCH ST STE 100",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926601781",
"telephone_number": "949-259-5054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLACK",
"first_name": "KATHRYN",
"middle_name": "NICHOLE",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-14",
"last_updated": "2022-11-14",
"certification_date": "2022-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "36439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.