Provider Demographics
NPI:1184843146
Name:MIRANDO, ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MIRANDO
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 1:4530 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4328
Mailing Address - Country:US
Mailing Address - Phone:202-244-4444
Mailing Address - Fax:202-244-4439
Practice Address - Street 1:4530 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4328
Practice Address - Country:US
Practice Address - Phone:202-244-4444
Practice Address - Fax:202-244-4439
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH14831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCH14831OtherCHIROPRACTIC LICENSE