Provider Demographics
NPI:1568223980
Name:D'AMICO, ANTHONY RAYMOND (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:D'AMICO
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 1:203 FRONT PORCH CT
Mailing Address - Street 2:208 RIVERSTONE WAY
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-1117
Mailing Address - Country:US
Mailing Address - Phone:724-321-2726
Mailing Address - Fax:
Practice Address - Street 1:4521 MONTGOMERY HWY STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1687
Practice Address - Country:US
Practice Address - Phone:334-539-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor