Provider Demographics
NPI:1417956863
Name:MANOLAKOS, DOUGLAS B (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:MANOLAKOS
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 1:1000 LINTON BLVD
Mailing Address - Street 2:SUITE A7
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1123
Mailing Address - Country:US
Mailing Address - Phone:561-272-0388
Mailing Address - Fax:561-272-0498
Practice Address - Street 1:1000 LINTON BLVD
Practice Address - Street 2:SUITE A7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1123
Practice Address - Country:US
Practice Address - Phone:561-272-0388
Practice Address - Fax:561-272-0498
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6359111N00000X
GACHIRO003117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22784Medicare ID - Type Unspecified
U34693Medicare UPIN