Provider Demographics
NPI:1275735482
Name:MANASCO CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:MANASCO CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOROWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MANASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-924-0050
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-0187
Mailing Address - Country:US
Mailing Address - Phone:205-924-0050
Mailing Address - Fax:205-924-0065
Practice Address - Street 1:32020 1ST AVENUE NW
Practice Address - Street 2:
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549
Practice Address - Country:US
Practice Address - Phone:205-924-0050
Practice Address - Fax:205-924-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU66039Medicare UPIN