MEDICARE: DR. MATTHEW MICHAEL DIDURO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X007847	NY
2	111N00000X	Chiropractor	2134	NC
3	111N00000X	Chiropractor	1905	SC
4	111N00000X	Chiropractor	CHIR005305	GA

General Provider Information

NPI Number	:	1376514638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MICHAEL DIDURO D.C.

Provider Business Mailing Address
First Line	:	766 FAIRFIELD DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4104
Country	:	US
Telephone Number	:	404-402-1903
Fax Number	:	678-909-0659

Provider Business Practice Location Address
First Line	:	4535 WINTERS CHAPEL RD
Second Line	:	SUITE B
City	:	DORAVILLE
State	:	GA
Zip	:	30360-2705
Country	:	US
Telephone Number	:	678-957-0266
Fax Number	:	678-909-0659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	10/29/2014

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