Provider Demographics
NPI:1326459520
Name:DIMALANTA, ALBERT JOSEPH (DC, CNS)
Entity Type:Individual
Prefix:
First Name:ALBERT JOSEPH
Middle Name:
Last Name:DIMALANTA
Suffix:
Gender:M
Credentials:DC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 S MARINE CORPS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3510
Mailing Address - Country:US
Mailing Address - Phone:671-649-4871
Mailing Address - Fax:
Practice Address - Street 1:782 S MARINE CORPS DR STE 101
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3510
Practice Address - Country:US
Practice Address - Phone:671-649-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUC-27111NR0400X
GUNUT-05133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education