Provider Demographics
NPI:1285070656
Name:MATTHEW VINSON CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MATTHEW VINSON CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-298-6325
Mailing Address - Street 1:1305 N WILLOW AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-4866
Mailing Address - Country:US
Mailing Address - Phone:559-298-6325
Mailing Address - Fax:559-298-6322
Practice Address - Street 1:1305 N WILLOW AVE STE 160
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-4866
Practice Address - Country:US
Practice Address - Phone:559-298-6325
Practice Address - Fax:559-298-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty