Provider Demographics
NPI:1114796315
Name:CLEVENGER, MATTHEW SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:CLEVENGER
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 1:3230 S EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7818
Mailing Address - Country:US
Mailing Address - Phone:903-465-1881
Mailing Address - Fax:903-463-4070
Practice Address - Street 1:3230 S EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-7818
Practice Address - Country:US
Practice Address - Phone:903-465-1881
Practice Address - Fax:903-463-4070
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor