Healthcare Provider Details

I. General information

NPI: 1902909286
Provider Name (Legal Business Name): ANTHONY PETER LAMANNA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 E GREENWAY RD SUITE 104
PHOENIX AZ
85032-4805
US

IV. Provider business mailing address

4219 E PALO BREA LN
CAVE CREEK AZ
85331-3864
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-0717
  • Fax: 602-424-7778
Mailing address:
  • Phone: 602-494-0717
  • Fax: 602-424-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5744
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: