MEDICARE: DR. MATT'S WELLNESS CENTER P.L.L.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	111N00000X	Chiropractor	8459	TX

General Provider Information

NPI Number	:	1487988069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MATT'S WELLNESS CENTER P.L.L.C.

Provider Business Mailing Address
First Line	:	4031 W PLANO PKWY
Second Line	:	SUITE 201
City	:	PLANO
State	:	TX
Zip	:	75093-5619
Country	:	US
Telephone Number	:	972-867-9900
Fax Number	:	972-867-9932

Provider Business Practice Location Address
First Line	:	4031 W PLANO PKWY
Second Line	:	SUITE 201
City	:	PLANO
State	:	TX
Zip	:	75093-5619
Country	:	US
Telephone Number	:	972-867-9900
Fax Number	:	972-867-9932

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. IZMIT KULAFOFSKI
Credential	:	D.C.
Telephone Number	:	972-867-9900

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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