Provider Demographics
NPI:1699531855
Name:RICHIEZ MATOS, EXCER (DC)
Entity type:Individual
Prefix:DR
First Name:EXCER
Middle Name:
Last Name:RICHIEZ MATOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 HARMON AVE UNIT 321
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4680
Mailing Address - Country:US
Mailing Address - Phone:939-235-5435
Mailing Address - Fax:
Practice Address - Street 1:1701 W BEN WHITE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7679
Practice Address - Country:US
Practice Address - Phone:512-441-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor