Provider Demographics
NPI:1841697679
Name:MATUSIEWICZ, LUKASZ
Entity type:Individual
Prefix:
First Name:LUKASZ
Middle Name:
Last Name:MATUSIEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 LAKEVIEW PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4090
Mailing Address - Country:US
Mailing Address - Phone:972-412-4442
Mailing Address - Fax:972-412-4469
Practice Address - Street 1:3538 LAKEVIEW PKWY
Practice Address - Street 2:STE 100
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4090
Practice Address - Country:US
Practice Address - Phone:972-412-4442
Practice Address - Fax:972-412-4469
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382520ZLEKMedicare PIN