Provider Demographics
NPI:1518677921
Name:MUNOZ, MATTHEW ISAAC (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ISAAC
Last Name:MUNOZ
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 1:1624 N LEE TREVINO DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5100
Mailing Address - Country:US
Mailing Address - Phone:915-598-2225
Mailing Address - Fax:
Practice Address - Street 1:1624 N LEE TREVINO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5100
Practice Address - Country:US
Practice Address - Phone:915-598-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty