Provider Demographics
NPI:1356512958
Name:DR MATTHEW C SUPRAN P A
Entity type:Organization
Organization Name:DR MATTHEW C SUPRAN P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SUPRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-278-2200
Mailing Address - Street 1:2275 S FEDERAL HWY STE 280
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3352
Mailing Address - Country:US
Mailing Address - Phone:561-278-2200
Mailing Address - Fax:561-278-0234
Practice Address - Street 1:2275 S FEDERAL HWY STE 280
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3352
Practice Address - Country:US
Practice Address - Phone:561-278-2200
Practice Address - Fax:561-278-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty