Provider Demographics
NPI:1477543098
Name:MANUCCI, JEFFREY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:MANUCCI
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 1:2236 WEST 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506
Mailing Address - Country:US
Mailing Address - Phone:814-868-2663
Mailing Address - Fax:814-868-0044
Practice Address - Street 1:2236 WEST 38TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506
Practice Address - Country:US
Practice Address - Phone:814-868-2663
Practice Address - Fax:814-868-0044
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005117L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001432216000Medicaid
PA0014322160003Medicaid
PA335-715OtherBLUE SHIELD GROUP NUMBER
PA182925OtherBLUE SHIELD
PA182925OtherKHPW
PAJM1033899OtherASHN
PA182925OtherKHPW
PA182925OtherBLUE SHIELD