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NPI Code Detail

MEDICARE: DR. MATTHEW ALTON MISHIO D.C.

MEDICARE: DR. MATTHEW ALTON MISHIO D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor38MC00626100NJ
2111N00000XChiropractorDC-007938-LPA
3111N00000XChiropractor11641TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MI-906445OTHERPABC/BS NUMBER

General Provider Information

NPI Number : 1730181041
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW ALTON MISHIO D.C.
Provider Business Mailing Address
First Line : 7500 BOULEVARD 26
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-8318
Country : US
Telephone Number : 817-259-1300
Fax Number : 817-284-8240
Provider Business Practice Location Address
First Line : 7500 BOULEVARD 26
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-8318
Country : US
Telephone Number : 817-259-1300
Fax Number : 817-284-8240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 04/11/2011

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