Provider Demographics
NPI:1487988069
Name:DR. MATT'S WELLNESS CENTER P.L.L.C.
Entity type:Organization
Organization Name:DR. MATT'S WELLNESS CENTER P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IZMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KULAFOFSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-867-9900
Mailing Address - Street 1:4031 W PLANO PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5619
Mailing Address - Country:US
Mailing Address - Phone:972-867-9900
Mailing Address - Fax:972-867-9932
Practice Address - Street 1:4031 W PLANO PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5619
Practice Address - Country:US
Practice Address - Phone:972-867-9900
Practice Address - Fax:972-867-9932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty