Provider Demographics
NPI:1194223560
Name:ALMANZA, MARIO JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JOSEPH
Last Name:ALMANZA
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 1:1951 SW PALM CITY RD APT 26I
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4346
Mailing Address - Country:US
Mailing Address - Phone:810-488-6400
Mailing Address - Fax:
Practice Address - Street 1:1044 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4706
Practice Address - Country:US
Practice Address - Phone:810-488-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor