Provider Demographics
NPI:1992172324
Name:DILALLO, MATTHEW (DC, MA, CSCS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:DILALLO
Suffix:
Gender:M
Credentials:DC, MA, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE A101
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3479
Mailing Address - Country:US
Mailing Address - Phone:561-402-4701
Mailing Address - Fax:561-720-2056
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE A101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3479
Practice Address - Country:US
Practice Address - Phone:561-402-4701
Practice Address - Fax:561-720-2056
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor