Active NPI
Matthew Dilallo, DC, MA, CSCS
- Chiropractor
- Palm Beach Gardens, FL
National Provider Identifier
1992172324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH 11621
- Practice address
- 11211 Prosperity Farms Rd Ste A101
Palm Beach Gardens, FL 33410-3479 - Phone
- (561) 402-4701
- Fax
- (561) 720-2056
- NPI assigned
- Sep 2, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH 11621 | FL | Primary |
Addresses
Primary practice location
11211 Prosperity Farms Rd Ste A101
Palm Beach Gardens, FL 33410-3479
Mailing address
11211 Prosperity Farms Rd Ste A101
Palm Beach Gardens, FL 33410-3479
Phone (561) 402-4701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190409002495 | FL | Practitioner - Chiropractic | 4183965718 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH 11621 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545091200000",
"number": "1992172324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11211 PROSPERITY FARMS RD STE A101",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334103479",
"telephone_number": "561-402-4701",
"fax_number": "561-720-2056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11211 PROSPERITY FARMS RD STE A101",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334103479",
"telephone_number": "561-402-4701",
"fax_number": "561-720-2056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILALLO",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DC, MA, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-02",
"last_updated": "2018-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH 11621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Beach Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.