=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487849980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW FRANK MENDILLO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2007
-----------------------------------------------------
Last Update Date | 09/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 N MAIN ST
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-431-2155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 N MAIN ST
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-431-2155
-----------------------------------------------------
Fax | 732-431-2889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DCP00559
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3653
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00723600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------