Provider Demographics
NPI:1841398856
Name:LAMANNA, ALBERT V (DC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:V
Last Name:LAMANNA
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 1:1512 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6013
Mailing Address - Country:US
Mailing Address - Phone:843-238-6070
Mailing Address - Fax:843-238-6071
Practice Address - Street 1:1514 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6013
Practice Address - Country:US
Practice Address - Phone:843-238-6070
Practice Address - Fax:843-238-6071
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1791Medicaid
SC200195677OtherBCBS
SC7866Medicare ID - Type Unspecified
SC200195677OtherBCBS