Provider Demographics
NPI:1881626109
Name:MATRIX CHIROPRACTIC
Entity type:Organization
Organization Name:MATRIX CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:THUTUYEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAMLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-432-3080
Mailing Address - Street 1:4848 LEMMON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1400
Mailing Address - Country:US
Mailing Address - Phone:214-432-3080
Mailing Address - Fax:214-347-9571
Practice Address - Street 1:4848 LEMMON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1400
Practice Address - Country:US
Practice Address - Phone:214-432-3080
Practice Address - Fax:214-347-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty