Provider Demographics
NPI:1225026347
Name:HIDALGO, MANUEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:HIDALGO
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 1:1181 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3115
Mailing Address - Country:US
Mailing Address - Phone:305-279-2767
Mailing Address - Fax:305-884-8391
Practice Address - Street 1:7171 CORAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1684
Practice Address - Country:US
Practice Address - Phone:305-279-2767
Practice Address - Fax:305-884-8391
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3052792767OtherAVMED INSURANCE
FL381467000Medicaid
FL381467000Medicaid