Provider Demographics
NPI:1538679741
Name:DELGADO, MATTHEW KRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KRISTOPHER
Last Name:DELGADO
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 1:2612 S LAMAR BLVD # A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4733
Mailing Address - Country:US
Mailing Address - Phone:512-400-1241
Mailing Address - Fax:
Practice Address - Street 1:2612 S LAMAR BLVD # A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4733
Practice Address - Country:US
Practice Address - Phone:512-400-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor