Organization
DONALD P. MAMMANO, D.C., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD PETER MAMMANO D.C., F.A.C.O. (PHYSICIAN)
(815) 434-5555
Entity
Organization
Contact information
Practice address
1304 GEMINI CIR, SUITE 2, OTTAWA, IL 61350-1689
(815) 434-5555
(815) 434-5568
Mailing address
1304 GEMINI CIR, SUITE 2, OTTAWA, IL 61350-1689
(815) 434-5555
(815) 434-5568
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
038-003506
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5015067-69
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
04/24/2007
Last updated
06/13/2008
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