Provider Demographics
NPI:1164614087
Name:LAMANNA FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LAMANNA FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LAMANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-494-0717
Mailing Address - Street 1:4646 E GREENWAY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4805
Mailing Address - Country:US
Mailing Address - Phone:602-494-0717
Mailing Address - Fax:602-424-7778
Practice Address - Street 1:4646 E GREENWAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4805
Practice Address - Country:US
Practice Address - Phone:602-494-0717
Practice Address - Fax:602-424-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0930640OtherBLUECROSS BLUE SHIELD
AZZ20383Medicare PIN