Provider Demographics
NPI:1558510206
Name:JOHN P. MANFEDI D.C. P.C.
Entity Type:Organization
Organization Name:JOHN P. MANFEDI D.C. P.C.
Other - Org Name:ADVANCED CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-699-6763
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005560261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty