MEDICARE: DR. MATTHEW DAVID COSTANTINO D.C.

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	111NR0400X	Rehabilitation Chiropractor	21279	CA

General Provider Information

NPI Number	:	1447463096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DAVID COSTANTINO D.C.

Provider Business Mailing Address
First Line	:	1100 PACIFIC COAST HWY
Second Line	:	SUITE A
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3921
Country	:	US
Telephone Number	:	310-798-3227
Fax Number	:	310-798-3229

Provider Business Practice Location Address
First Line	:	1100 PACIFIC COAST HWY
Second Line	:	SUITE A
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3921
Country	:	US
Telephone Number	:	310-798-3227
Fax Number	:	310-798-3229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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