MEDICARE: PALLADINO ENTERPRISES LLC

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

General Provider Information

NPI Number	:	1598382749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLADINO ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	108 APPLE CT
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-1703
Country	:	US
Telephone Number	:	402-297-8848
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 W MAIN ST
Second Line	:
City	:	NORTH MANCHESTER
State	:	IN
Zip	:	46962-1508
Country	:	US
Telephone Number	:	402-297-7900
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. MATTHEW PALLADINO
Credential	:	DC
Telephone Number	:	402-297-7900

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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Directions to “PALLADINO ENTERPRISES LLC ” Practice Location

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