=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740674753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J. DIMAIO D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2015
-----------------------------------------------------
Last Update Date | 03/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 WADING RIVER RD
-----------------------------------------------------
City | MANORVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11949-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-909-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 WADING RIVER RD
-----------------------------------------------------
City | MANORVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11949-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-909-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL JOHN DIMAIO
-----------------------------------------------------
Credential | CDC.C.
-----------------------------------------------------
Telephone | 631-909-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X055961
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------