Provider Demographics
NPI:1194879312
Name:MATA, SHIRLEY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:MATA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 962037
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-2037
Mailing Address - Country:US
Mailing Address - Phone:915-252-9832
Mailing Address - Fax:915-594-8972
Practice Address - Street 1:10600 MONTWOOD DR
Practice Address - Street 2:SUITE 113
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2700
Practice Address - Country:US
Practice Address - Phone:915-252-9832
Practice Address - Fax:915-595-6953
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6402111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0227Medicare PIN