Provider Demographics
NPI:1043399470
Name:MANZO, PETER BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRIAN
Last Name:MANZO
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 1:740 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4635
Mailing Address - Country:US
Mailing Address - Phone:817-860-1618
Mailing Address - Fax:817-860-1618
Practice Address - Street 1:740 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4635
Practice Address - Country:US
Practice Address - Phone:817-860-1618
Practice Address - Fax:817-860-1618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603962Medicare ID - Type UnspecifiedBCBS PROVIDER NO.