Provider Demographics
NPI:1477670339
Name:MANFREDI, JOHN P (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MANFREDI
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 1:704 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2111
Mailing Address - Country:US
Mailing Address - Phone:914-699-6763
Mailing Address - Fax:914-699-0070
Practice Address - Street 1:704 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2111
Practice Address - Country:US
Practice Address - Phone:914-699-6763
Practice Address - Fax:914-699-0070
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX35611Medicare PIN