Provider Demographics
NPI:1679296818
Name:MATOS, DENNIS JARED (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JARED
Last Name:MATOS
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 1:376 BOYLSTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3827
Mailing Address - Country:US
Mailing Address - Phone:857-250-2939
Mailing Address - Fax:
Practice Address - Street 1:376 BOYLSTON ST STE 301
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3827
Practice Address - Country:US
Practice Address - Phone:857-250-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3810111NR0400X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician