MEDICARE: DR MATTHEW C SUPRAN P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7553	FL

General Provider Information

NPI Number	:	1356512958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MATTHEW C SUPRAN P A

Provider Business Mailing Address
First Line	:	2275 S FEDERAL HWY STE 280
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3352
Country	:	US
Telephone Number	:	561-278-2200
Fax Number	:	561-278-0234

Provider Business Practice Location Address
First Line	:	2275 S FEDERAL HWY STE 280
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3352
Country	:	US
Telephone Number	:	561-278-2200
Fax Number	:	561-278-0234

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW CHARLES SUPRAN
Credential	:	DC
Telephone Number	:	561-278-2200

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/26/2008

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