Provider Demographics
NPI:1629081070
Name:MATHES, LOREN ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:ARTHUR
Last Name:MATHES
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 1:2925 SOUTHWEST PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4100
Mailing Address - Country:US
Mailing Address - Phone:940-691-3200
Mailing Address - Fax:940-691-7715
Practice Address - Street 1:2925 SOUTHWEST PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4100
Practice Address - Country:US
Practice Address - Phone:940-691-3200
Practice Address - Fax:940-691-7715
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5761TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8251749OtherBLUE LINK #
TX8251749OtherBLUE LINK #
TXU51749Medicare UPIN