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General NPI Number Information
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NPI Number | 1558686014
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Entity Type | Individual
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Provider Name | MATTHEW JOHN TAVOLACCI D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2010
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 12797 FOREST HILL BLVD SUITE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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Country | US
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Telephone | 561-793-5550
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Fax | 561-793-5788
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Provider Business Mailing Address
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Address Line | 12797 FOREST HILL BLVD SUITE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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Country | US
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Telephone | 561-793-5550
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Fax | 561-793-5788
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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 | CHIR008631
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License Number State | GA
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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 | CH10273
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License Number State | FL
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