Provider Demographics
NPI:1629081237
Name:MANISCALCO, JOSEPH JAMES (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:MANISCALCO
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 1:305 IGNACIO VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5565
Mailing Address - Country:US
Mailing Address - Phone:415-883-4358
Mailing Address - Fax:415-883-4358
Practice Address - Street 1:305 IGNACIO VALLEY CIR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5565
Practice Address - Country:US
Practice Address - Phone:415-883-4358
Practice Address - Fax:415-883-4358
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0072220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor