Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH6639 | FL |
NPI | 1083641211 |
---|---|
Provider Name | Dr. John Andrew D'amico |
First Address | Lake Worth, FL 33461-4000 |
Second Address | Miami, FL 33125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55190 | (02) | FL |