Healthcare Provider Details

I. General information

NPI: 1972789006
Provider Name (Legal Business Name): DAVID J. D'AMICO CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N FORTUNA BLVD
FORTUNA CA
95540-2724
US

IV. Provider business mailing address

431 N FORTUNA BLVD
FORTUNA CA
95540-2724
US

V. Phone/Fax

Practice location:
  • Phone: 707-726-9179
  • Fax: 707-726-9197
Mailing address:
  • Phone: 707-726-9179
  • Fax: 707-726-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29122
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID JOSEPH D'AMICO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 707-726-9179