Provider Demographics
NPI:1487625687
Name:MANASCO, ROBERT BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:MANASCO
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 1:312 YELLOW JACKET RD
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-3506
Mailing Address - Country:US
Mailing Address - Phone:205-924-3018
Mailing Address - Fax:
Practice Address - Street 1:32020 NW 1ST AVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501059Medicare ID - Type Unspecified
ALU66039Medicare UPIN