Provider Demographics
NPI:1790184562
Name:STANUSZEK, AMANDA (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STANUSZEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S PACIFIC COAST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5003
Mailing Address - Country:US
Mailing Address - Phone:310-543-7779
Mailing Address - Fax:310-961-5942
Practice Address - Street 1:1300 S PACIFIC COAST HWY STE 201
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5003
Practice Address - Country:US
Practice Address - Phone:310-543-7779
Practice Address - Fax:310-961-5942
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor