Provider Demographics
NPI:1093206880
Name:CAPITOL CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:CAPITOL CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-614-0048
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-0508
Mailing Address - Country:US
Mailing Address - Phone:973-614-0048
Mailing Address - Fax:973-767-1330
Practice Address - Street 1:157 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5128
Practice Address - Country:US
Practice Address - Phone:973-614-0048
Practice Address - Fax:973-767-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
38MC00521900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ$$$$$$$$$OtherSOCIAL SECURITY