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General NPI Number Information
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NPI Number | 1598382749
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Entity Type | Organization
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Legal Business Name | PALLADINO ENTERPRISES LLC
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 408 W MAIN ST
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City | NORTH MANCHESTER
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State | IN
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Zip | 46962-1508
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Country | US
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Telephone | 402-297-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 108 APPLE CT
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City | WINONA LAKE
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State | IN
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Zip | 46590-1703
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Country | US
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Telephone | 402-297-8848
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. MATTHEW PALLADINO
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Credential | DC
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Telephone | 402-297-7900
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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 |
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License Number State |
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