Provider Demographics
NPI:1891760534
Name:D'AMANDA, JOHN (NMD, CTTP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:D'AMANDA
Suffix:
Gender:M
Credentials:NMD, CTTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:888-808-4445
Mailing Address - Fax:940-365-5887
Practice Address - Street 1:500 MARQUETTE AVE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:888-808-4445
Practice Address - Fax:940-365-5887
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8241111NI0900X
NMMD3816812208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No111NI0900XChiropractic ProvidersChiropractorInternist