Provider Demographics
NPI:1821183641
Name:VANAMBERG, DAVID JEHRING (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEHRING
Last Name:VANAMBERG
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 1:606 METACOM AVENUE
Mailing Address - Street 2:VANAMBERG FAMILY CHIROPRACTIC #5
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2806
Mailing Address - Country:US
Mailing Address - Phone:401-245-6294
Mailing Address - Fax:401-245-6295
Practice Address - Street 1:606 METACOM AVENUE
Practice Address - Street 2:#5
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2806
Practice Address - Country:US
Practice Address - Phone:401-245-6294
Practice Address - Fax:401-245-6295
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC00421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409846OtherBCBS BLUE CHIP
RIRI231260OtherBCBS
RI35923126Medicare ID - Type Unspecified