Active NPI
Matthew D Hales, DC
- Chiropractor
- Meridian, ID
National Provider Identifier
1295742690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIA-1153
- Practice address
- 1640 W Cherry LN Ste 130
Meridian, ID 83642-1321 - Phone
- (208) 895-8595
- Fax
- (208) 884-1835
- NPI assigned
- Aug 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | CHIA-1153 | ID | Primary |
Addresses
Primary practice location
1640 W Cherry LN Ste 130
Meridian, ID 83642-1321
Mailing address
1640 W Cherry LN Ste 130
Meridian, ID 83642-1321
Phone (208) 895-8595
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-1153 | ID | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evergreen Physical Medicine, LLC | Past | Accepting new patients | |
| Evergreen Wellness Partners, LLC | Chiropractor | Past | Accepting new patients |
| Evergreen Wellness Group LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Evergreen Chiropractic
- Chiropractor
- Meridian, ID
- NPI 1417096256
-
dba Evergreen Physical Medicine
- Family Nurse Practitioner
- Meridian, ID
- NPI 1538668421
-
dba Evergreen Wellness Studios
- Chiropractor
- Meridian, ID
- NPI 1811402431
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295742690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 W CHERRY LN STE 130",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421321",
"telephone_number": "208-895-8595",
"fax_number": "208-884-1835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 W CHERRY LN STE 130",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421321",
"telephone_number": "208-895-8595",
"fax_number": "208-884-1835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALES",
"first_name": "MATTHEW",
"middle_name": "D",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "CHIA-1153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.