MEDICARE: DHAN MATHEW

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	12644	TX

General Provider Information

NPI Number	:	1487060968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHAN MATHEW

Provider Business Mailing Address
First Line	:	4218 N MEADE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1520
Country	:	US
Telephone Number	:	312-401-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	33300 EGYPT LN STE B400
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-2872
Country	:	US
Telephone Number	:	281-789-4182
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	07/07/2014

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Directions to “ DHAN MATHEW ” Practice Location

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