Provider Demographics
NPI:1912031188
Name:MIX, MATTHEW MORGAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MORGAN
Last Name:MIX
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 1:807 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3807
Mailing Address - Country:US
Mailing Address - Phone:512-321-9200
Mailing Address - Fax:512-321-9201
Practice Address - Street 1:807 MAIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3807
Practice Address - Country:US
Practice Address - Phone:512-321-9200
Practice Address - Fax:512-321-9201
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor