MEDICARE: MATULKA CHIROPRACTIC LLC

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1871316133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATULKA CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1623 E 4TH AVE UNIT 106
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-5109
Country	:	US
Telephone Number	:	813-248-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 E 4TH AVE UNIT 106
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-5109
Country	:	US
Telephone Number	:	813-248-2900
Fax Number	:	813-248-2933

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL MATULKA
Credential	:	DC
Telephone Number	:	813-248-2900

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	12/30/2024

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