MEDICARE: DR. MATTHEW DILALLO DC, MA, CSCS

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	CH 11621	FL

General Provider Information

NPI Number	:	1992172324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DILALLO DC, MA, CSCS

Provider Business Mailing Address
First Line	:	11211 PROSPERITY FARMS RD STE A101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3479
Country	:	US
Telephone Number	:	561-402-4701
Fax Number	:	561-720-2056

Provider Business Practice Location Address
First Line	:	11211 PROSPERITY FARMS RD STE A101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3479
Country	:	US
Telephone Number	:	561-402-4701
Fax Number	:	561-720-2056

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	12/18/2018

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