MEDICARE: DR. SHIRLEY ANN MATA 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
1	111NX0100X	Occupational Health Chiropractor	DC6402	TX

General Provider Information

NPI Number	:	1194879312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY ANN MATA D.C

Provider Business Mailing Address
First Line	:	PO BOX 962037
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79996-2037
Country	:	US
Telephone Number	:	915-252-9832
Fax Number	:	915-594-8972

Provider Business Practice Location Address
First Line	:	10600 MONTWOOD DR
Second Line	:	SUITE 113
City	:	EL PASO
State	:	TX
Zip	:	79935-2700
Country	:	US
Telephone Number	:	915-252-9832
Fax Number	:	915-595-6953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/16/2014

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Directions to “ DR. SHIRLEY ANN MATA D.C” Practice Location

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