Provider Demographics
NPI:1528203023
Name:MANEGGIA, MATTHEW (LAC, DA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MANEGGIA
Suffix:
Gender:M
Credentials:LAC, DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1826
Mailing Address - Country:US
Mailing Address - Phone:860-794-8182
Mailing Address - Fax:860-233-8110
Practice Address - Street 1:17 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1826
Practice Address - Country:US
Practice Address - Phone:860-794-8182
Practice Address - Fax:860-233-8110
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist