Provider Demographics
NPI:1902909286
Name:LAMANNA, ANTHONY PETER JR (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PETER
Last Name:LAMANNA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4219 E PALO BREA LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3864
Mailing Address - Country:US
Mailing Address - Phone:602-494-0717
Mailing Address - Fax:602-424-7778
Practice Address - Street 1:4646 E GREENWAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4805
Practice Address - Country:US
Practice Address - Phone:602-494-0717
Practice Address - Fax:602-424-7778
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0930640OtherBLUE CROSS BLUE SHIELD ID
AZZ20383Medicare ID - Type UnspecifiedPROVIDER NUMBER