Provider Demographics
NPI:1740206572
Name:MAMMANA, THOMAS FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANK
Last Name:MAMMANA
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 1:26262 HWY 441 SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-307-0033
Mailing Address - Fax:352-307-1998
Practice Address - Street 1:26262 HWY 441 SUITE 200
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-307-0033
Practice Address - Fax:352-307-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3813525-00Medicaid
FL55709Medicare UPIN
FL3813525-00Medicaid