Provider Demographics
NPI:1780440891
Name:WAINFAN, AMANDA LEIGH (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:WAINFAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 MESA VERDE DR E STE 108
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5221
Mailing Address - Country:US
Mailing Address - Phone:714-502-4243
Mailing Address - Fax:866-622-9879
Practice Address - Street 1:1525 MESA VERDE DR E STE 108
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5221
Practice Address - Country:US
Practice Address - Phone:714-502-4243
Practice Address - Fax:866-622-9879
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36915111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation