Provider Demographics
NPI:1306014493
Name:MATLOCK CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:MATLOCK CHIROPRACTIC, P.A.
Other - Org Name:MATLOCK CHIRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSD
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-746-8482
Mailing Address - Street 1:2525 MILITARY TRL
Mailing Address - Street 2:UNIT 103
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7883
Mailing Address - Country:US
Mailing Address - Phone:561-746-8482
Mailing Address - Fax:561-746-8452
Practice Address - Street 1:2525 MILITARY TRL
Practice Address - Street 2:UNIT 103
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7883
Practice Address - Country:US
Practice Address - Phone:561-746-8482
Practice Address - Fax:561-746-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty