Provider Demographics
NPI:1083903082
Name:CHIRO MATRIX, P.A.
Entity Type:Organization
Organization Name:CHIRO MATRIX, P.A.
Other - Org Name:PHYSICIANS INJURY AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUSBANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-403-5820
Mailing Address - Street 1:1948 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3221
Mailing Address - Country:US
Mailing Address - Phone:407-403-5820
Mailing Address - Fax:321-251-6214
Practice Address - Street 1:1948 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3221
Practice Address - Country:US
Practice Address - Phone:407-403-5820
Practice Address - Fax:321-251-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN