Provider Demographics
NPI:1043491368
Name:MANZOLILLO CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:MANZOLILLO CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZOLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:4012-733-0046
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3007
Mailing Address - Country:US
Mailing Address - Phone:401-273-0046
Mailing Address - Fax:401-273-4100
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3007
Practice Address - Country:US
Practice Address - Phone:401-273-0046
Practice Address - Fax:401-273-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC00321261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU9015OtherUPIN#