Ian Daniel Matlack

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

100 E Normal Ave
Kirksville, MO 63501-4200

Phone

(816) 244-7674

NPI assigned

Jul 31, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1417638685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 ANGELIQUE ST",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645013436",
            "telephone_number": "816-244-7674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E NORMAL AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014200",
            "telephone_number": "816-244-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLACK",
        "first_name": "IAN",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-31",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Roy Martel
• Martin J Borrok DMD PC
• Collin Murray Martin
• Heather R Martin, D.O.
• Chelsea Mastagni
• Jacob Thomas Matschiner, DMD
• Ryan Mauro, DO
• Cynthia Ann Mayberry, APRN
• Robin Mayer
• Diane Renae Mayes, DPT

• Athletic Trainer in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.