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General NPI Number Information
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NPI Number | 1255513602
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC REHABILITATION AND WELLNESS CENTER
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 15151 S US HIGHWAY 441
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City | SUMMERFIELD
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State | FL
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Zip | 34491-4481
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Country | US
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Telephone | 352-307-0033
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Fax | 352-307-1998
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Provider Business Mailing Address
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Address Line | 15151 S US HIGHWAY 441 SUITE 200
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City | SUMMERFIELD
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State | FL
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Zip | 34491-4481
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Country | US
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Telephone | 352-307-0033
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Fax | 352-307-1998
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS FRANK MAMMANA
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Credential | CHIROPRACTOR
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Telephone | 352-307-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | CH2831
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH2831
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License Number State | FL
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