Provider Demographics
NPI:1174543672
Name:DEAN W. MAMMALES DC LLC
Entity type:Organization
Organization Name:DEAN W. MAMMALES DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAMMALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-753-2225
Mailing Address - Street 1:10233 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1406
Mailing Address - Country:US
Mailing Address - Phone:561-753-2225
Mailing Address - Fax:561-296-0378
Practice Address - Street 1:10233 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE B-6
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1406
Practice Address - Country:US
Practice Address - Phone:561-753-2225
Practice Address - Fax:561-296-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty