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General NPI Number Information
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NPI Number | 1619483005
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Entity Type | Organization
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Legal Business Name | RED LOTUS SERVICES LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 45 MANOR HILL DR STE 300
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City | CANFIELD
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State | OH
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Zip | 44406-1538
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Country | US
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Telephone | 234-414-7130
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Fax | 330-629-9339
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Provider Business Mailing Address
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Address Line | 45 MANOR HILL DR STE 300
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City | CANFIELD
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State | OH
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Zip | 44406-1538
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Country | US
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Telephone | 234-414-7130
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Fax | 330-629-9339
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ANDRIA MARIE D'AMATO
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Credential | DC, DABCA
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Telephone | 330-360-5918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4072
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License Number State | OH
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