Provider Demographics
NPI:1477718070
Name:MAMMANA CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:MAMMANA CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MAMMANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-867-7577
Mailing Address - Street 1:3256 NE JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-2802
Mailing Address - Country:US
Mailing Address - Phone:352-867-7577
Mailing Address - Fax:
Practice Address - Street 1:3256 NE JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-2802
Practice Address - Country:US
Practice Address - Phone:352-867-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3813525-00Medicaid
FLT52066OtherUPIN
FLAM658Medicare UPIN