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General NPI Number Information
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NPI Number | 1376514638
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL DIDURO D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 4535 WINTERS CHAPEL RD SUITE B
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City | DORAVILLE
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State | GA
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Zip | 30360-2705
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Country | US
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Telephone | 678-957-0266
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Fax | 678-909-0659
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Provider Business Mailing Address
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Address Line | 766 FAIRFIELD DR
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City | MARIETTA
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State | GA
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Zip | 30068-4104
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Country | US
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Telephone | 404-402-1903
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Fax | 678-909-0659
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X007847
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2134
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1905
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR005305
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License Number State | GA
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