MEDICARE: DR. MONYA MATTHIESEN TRACY 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	111N00000X	Chiropractor	10068	TX

General Provider Information

NPI Number	:	1841291119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONYA MATTHIESEN TRACY D.C.

Provider Business Mailing Address
First Line	:	800 W HIGHWAY 290
Second Line	:	BLDG F, STE 500
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4191
Country	:	US
Telephone Number	:	512-858-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W HIGHWAY 290
Second Line	:	BLDG F, STE 500
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4191
Country	:	US
Telephone Number	:	512-858-9355
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/05/2014

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