Provider Demographics
NPI:1053836668
Name:TALLEY, MATTHEW JOSHUA (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSHUA
Last Name:TALLEY
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 1:3409 WINDCHASE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2663
Mailing Address - Country:US
Mailing Address - Phone:469-475-5077
Mailing Address - Fax:
Practice Address - Street 1:215 S DENTON TAP RD STE 285
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5064
Practice Address - Country:US
Practice Address - Phone:972-304-3900
Practice Address - Fax:972-330-4768
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor