Provider Demographics
NPI:1235205220
Name:PANIAGUA, MANUEL BENEDICTO (DC)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:BENEDICTO
Last Name:PANIAGUA
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 1:594 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3805
Mailing Address - Country:US
Mailing Address - Phone:619-495-5802
Mailing Address - Fax:
Practice Address - Street 1:1391 WOODSIDE RD
Practice Address - Street 2:STE. 200
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3578
Practice Address - Country:US
Practice Address - Phone:650-365-7775
Practice Address - Fax:650-365-7896
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor