Healthcare Provider Details

I. General information

NPI: 1760305148
Provider Name (Legal Business Name): MATTHEW KISOR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SALZEDO ST STE 18
CORAL GABLES FL
33146-1752
US

IV. Provider business mailing address

7004 SW 40TH ST APT 126
MIAMI FL
33155-3868
US

V. Phone/Fax

Practice location:
  • Phone: 786-814-5198
  • Fax:
Mailing address:
  • Phone: 334-728-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: