Provider Demographics
NPI:1699705608
Name:MATKIN, CHARLES MITCHELL (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MITCHELL
Last Name:MATKIN
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:PO BOX 1103
Mailing Address - Street 2:727 EAST FERGUSON RD
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455
Mailing Address - Country:US
Mailing Address - Phone:903-572-0212
Mailing Address - Fax:903-572-5231
Practice Address - Street 1:727 E FURGUSON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-572-0212
Practice Address - Fax:903-572-5321
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001144701Medicaid
TX001144701Medicaid
TX601115Medicare ID - Type Unspecified