Healthcare Provider Details

I. General information

NPI: 1659761690
Provider Name (Legal Business Name): RAYMOND MATHEWS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W LOVE ST
MEXICO MO
65265-2704
US

IV. Provider business mailing address

422 W LOVE ST
MEXICO MO
65265-2704
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-2718
  • Fax: 573-581-0381
Mailing address:
  • Phone: 573-581-2718
  • Fax: 573-581-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10395
License Number StateTX

VIII. Authorized Official

Name: DR. RAYMOND FREDERICK MATHEWS
Title or Position: OWNER
Credential: D.C.
Phone: 636-399-8276