Provider Demographics
NPI:1104990332
Name:D'AMBRA, ANELLO JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ANELLO
Middle Name:JOHN
Last Name:D'AMBRA
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 1:2006 45TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-7315
Mailing Address - Country:US
Mailing Address - Phone:409-763-5900
Mailing Address - Fax:409-763-5916
Practice Address - Street 1:2006 45TH ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7315
Practice Address - Country:US
Practice Address - Phone:409-763-5900
Practice Address - Fax:409-763-5916
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M7070OtherBCBSTX PROVIDER NUMBER
TX8B6531Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX8M7070OtherBCBSTX PROVIDER NUMBER
TXU54176Medicare UPIN