Provider Demographics
NPI:1043350739
Name:DAMATO, ADRIAN ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ANTHONY
Last Name:DAMATO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 SOUTHWESTERN RUN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3671
Mailing Address - Country:US
Mailing Address - Phone:330-629-9292
Mailing Address - Fax:330-629-9339
Practice Address - Street 1:841 SOUTHWESTERN RUN
Practice Address - Street 2:SUITE 2
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3671
Practice Address - Country:US
Practice Address - Phone:330-629-9292
Practice Address - Fax:330-629-9339
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000136265OtherANTHEM
OH0608882Medicaid
OHP00317051OtherRAILROAD MEDICARE
OH0608882Medicaid
OHP00317051OtherRAILROAD MEDICARE
OHDA0539032Medicare ID - Type Unspecified