Provider Demographics
NPI:1851092027
Name:VILARDO, MASON (DC)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:VILARDO
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 1:1401 REED CANAL RD UNIT 17203
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-9491
Mailing Address - Country:US
Mailing Address - Phone:513-646-1823
Mailing Address - Fax:
Practice Address - Street 1:1166 MACK BAYOU RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3104
Practice Address - Country:US
Practice Address - Phone:513-646-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty