Provider Demographics
NPI:1659761690
Name:RAYMOND MATHEWS, LLC
Entity Type:Organization
Organization Name:RAYMOND MATHEWS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-399-8276
Mailing Address - Street 1:422 W LOVE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2704
Mailing Address - Country:US
Mailing Address - Phone:573-581-2718
Mailing Address - Fax:573-581-0381
Practice Address - Street 1:422 W LOVE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2704
Practice Address - Country:US
Practice Address - Phone:573-581-2718
Practice Address - Fax:573-581-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L0107Medicare PIN
TXV06241Medicare UPIN