Healthcare Provider Details

I. General information

NPI: 1568223980
Provider Name (Legal Business Name): ANTHONY RAYMOND D'AMICO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 W 11TH ST
ASHTABULA OH
44004-2906
US

IV. Provider business mailing address

584 OAKWOOD TRL
PAINESVILLE OH
44077-7620
US

V. Phone/Fax

Practice location:
  • Phone: 440-536-5475
  • Fax:
Mailing address:
  • Phone: 724-321-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number05512
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: