Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 8199 | TX |
NPI | 1417164054 |
---|---|
Provider Name | Dr. Matthew Yocom |
First Address | San Antonio, TX 78232-5052 |
Second Address | Dallas, TX 75204-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74037 | (02) | TX |