Provider Demographics
NPI:1124129507
Name:MINANA, FLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:
Last Name:MINANA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S AMPHLETT BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2520
Mailing Address - Country:US
Mailing Address - Phone:650-286-4288
Mailing Address - Fax:650-286-4291
Practice Address - Street 1:1660 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2520
Practice Address - Country:US
Practice Address - Phone:650-286-4288
Practice Address - Fax:650-286-4291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05378Medicare UPIN