Provider Demographics
NPI:1932576360
Name:PERFORMANCE AND WELLNESS CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:PERFORMANCE AND WELLNESS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DILALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MA, CSCS
Authorized Official - Phone:303-718-8562
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE A101
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3479
Mailing Address - Country:US
Mailing Address - Phone:561-402-4701
Mailing Address - Fax:561-720-2056
Practice Address - Street 1:11211 PROSPERITY FARMS RD UNIT A10
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3446
Practice Address - Country:US
Practice Address - Phone:561-402-4701
Practice Address - Fax:561-720-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty