Provider Demographics
NPI:1609108596
Name:DIMOND, MATHEW EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:EDWARD
Last Name:DIMOND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 E BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2538
Mailing Address - Country:US
Mailing Address - Phone:315-498-6888
Mailing Address - Fax:
Practice Address - Street 1:888 E BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2538
Practice Address - Country:US
Practice Address - Phone:315-498-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012040-1111N00000X
PADC010377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor