Provider Demographics
NPI:1144368879
Name:D'AMORE, MARIANNE
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:D'AMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 E STEARNS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5524
Mailing Address - Country:US
Mailing Address - Phone:949-444-9951
Mailing Address - Fax:949-444-9951
Practice Address - Street 1:2920 E STEARNS DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5524
Practice Address - Country:US
Practice Address - Phone:949-444-9951
Practice Address - Fax:949-444-9951
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 014582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14582AMedicare PIN