Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10395 | TX |
N | 111NN1001X | Nutrition | 10395 | TX |
NPI | 1629120118 |
---|---|
Provider Name | Raymond F Mathews |
First Address | Arlington, TX 76018-1532 |
Second Address | Arlington, TX 76018-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 27/07/2007 |