Provider Demographics
NPI:1700841889
Name:MANADERO, RHODERICK JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:RHODERICK
Middle Name:JOSE
Last Name:MANADERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:727 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1507
Mailing Address - Country:US
Mailing Address - Phone:757-595-8433
Mailing Address - Fax:757-595-9004
Practice Address - Street 1:727 J CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1507
Practice Address - Country:US
Practice Address - Phone:757-595-8433
Practice Address - Fax:757-595-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10290Medicare PIN