Provider Demographics
NPI:1679649610
Name:MANCINI, DAVID GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
Last Name:MANCINI
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 1:2059 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1751
Mailing Address - Country:US
Mailing Address - Phone:612-421-2128
Mailing Address - Fax:612-520-5121
Practice Address - Street 1:2059 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1751
Practice Address - Country:US
Practice Address - Phone:612-421-2128
Practice Address - Fax:612-520-5121
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06908111N00000X
MN4982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor