Provider Demographics
NPI:1447209911
Name:AMMON, DONALD J JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:AMMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 E BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6618
Mailing Address - Country:US
Mailing Address - Phone:956-373-9558
Mailing Address - Fax:
Practice Address - Street 1:1508 E BUSINESS 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6618
Practice Address - Country:US
Practice Address - Phone:956-373-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9924111N00000X
PADC009530111N00000X
IA06864111N00000X
OH3804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1714057Medicaid
IA0484931Medicaid
V03294Medicare UPIN
TX8D1021Medicare ID - Type Unspecified
TX1714057Medicaid
IAI17367Medicare ID - Type Unspecified