Provider Demographics
NPI:1972789006
Name:DAVID J. D'AMICO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DAVID J. D'AMICO CHIROPRACTIC, INC.
Other - Org Name:D'AMICO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-726-9179
Mailing Address - Street 1:431 N FORTUNA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2724
Mailing Address - Country:US
Mailing Address - Phone:707-726-9179
Mailing Address - Fax:707-726-9197
Practice Address - Street 1:431 N FORTUNA BLVD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2724
Practice Address - Country:US
Practice Address - Phone:707-726-9179
Practice Address - Fax:707-726-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty