Doctor Name: | VINCENT T MATTIELLO |
NPI Number: | 1306855168 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | CH9167 |
Business Practice Address: | 2845 Enterprise Rd Suite 101 Debary, FL - 327135224 |
Business Phone Number: | 3866689200 |
Business Fax Number: | 3866689200 |
Mailing Address: | 29 Big Buck Trl, ORMOND BEACH |
State: | FL |
Postal Code: | 321744279 |
Phone Number: | 3864050652 |
Fax Number: | |
NPI Enumeration Date: | 08/07/2006 |
NPI Last Update Date: | 03/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | CH9167 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |