Active NPI
Victor Bryceson Matthiesen, D.C.
- Chiropractor
- Coppell, TX
National Provider Identifier
1780418749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 16153
- Practice address
- 139 Mesquitewood St
Coppell, TX 75019-3583 - Phone
- (817) 964-1479
- NPI assigned
- Aug 30, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 16153 | TX | Primary |
Addresses
Primary practice location
139 Mesquitewood St
Coppell, TX 75019-3583
Mailing address
139 Mesquitewood St
Coppell, TX 75019-3583
Phone (817) 964-1479
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16153 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724976000000",
"number": "1780418749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "139 MESQUITEWOOD ST",
"city": "COPPELL",
"state": "TX",
"postal_code": "750193583",
"telephone_number": "817-964-1479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 MESQUITEWOOD ST",
"city": "COPPELL",
"state": "TX",
"postal_code": "750193583",
"telephone_number": "817-964-1479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHIESEN",
"first_name": "VICTOR",
"middle_name": "BRYCESON",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-30",
"last_updated": "2024-08-30",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "16153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coppell, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.