Individual provider Active NPI

Matthew Lerandal Talley, D.C.

  • Chiropractor
  • Dallas, GA
National Provider Identifier
1255613410
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR009342 Issued in GA
Practice address
1305 Cedarcrest Road Suite#111
Dallas, GA 30132
Phone
(770) 966-5014
NPI assigned
Sep 14, 2011
Last updated
Aug 20, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2343 AL
Chiropractor 111N00000X CHIR009342 GA Primary

Addresses

Primary practice location

1305 Cedarcrest Road Suite#111
Dallas, GA 30132

Mailing address

1305 Cedarcrest Road Suite#111
Dallas, GA 30132
Phone (770) 966-5014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220925000037 NC Practitioner - Chiropractic 3173780467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2010
Medicare assignment
May accept Medicare assignment
Group practices
Triangle Health Center PLLCGroup PAC ID 6901292150, 2 clinicians

Practice addresses (Care Compare)

1901 NW Cary Pkwy
Suite 111
Morrisville, NC 27560-7342
Phone (405) 640-3982

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4638NCMDBehavioral Analyst
CHIR009342GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Triangle Health Center PLLC Chiropractor CurrentSince Jun 16, 2022 Accepting new patients
Livingood Family Chiropractic, PC Chiropractor PastSince Jun 16, 2022 Accepting new patients

Locations

1901 NW Cary Pkwy
Ste 111
Morrisville, NC 27560
Phone (405) 640-3982

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1255613410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 CEDARCREST ROAD SUITE#111",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "30132",
            "telephone_number": "770-966-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 CEDARCREST ROAD SUITE#111",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "30132",
            "telephone_number": "770-966-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLEY",
        "first_name": "MATTHEW",
        "middle_name": "LERANDAL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-14",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AL",
            "license": "2343",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.