MEDICARE: MICHAEL J. DIMAIO D.C., P.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	X055961	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X055961	OTHER	NY	PTAN
2	1801079223	OTHER	NY	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1740674753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J. DIMAIO D.C., P.C.

Provider Business Mailing Address
First Line	:	306 WADING RIVER RD
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-3444
Country	:	US
Telephone Number	:	631-909-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 WADING RIVER RD
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-3444
Country	:	US
Telephone Number	:	631-909-1700
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MICHAEL JOHN DIMAIO
Credential	:	CDC.C.
Telephone Number	:	631-909-1700

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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