Provider Demographics
NPI:1245817980
Name:DA MATA, CAROLINA A M (DC)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:A M
Last Name:DA MATA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 CABELAS DR APT 223
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-6204
Mailing Address - Country:US
Mailing Address - Phone:517-230-3233
Mailing Address - Fax:
Practice Address - Street 1:102 S MEYER ST
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5686
Practice Address - Country:US
Practice Address - Phone:512-268-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor