Provider Demographics
NPI:1760735369
Name:EMANOIL, JOHN (LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:EMANOIL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9792 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6432
Mailing Address - Country:US
Mailing Address - Phone:515-512-6909
Mailing Address - Fax:
Practice Address - Street 1:9792 SUNSET TER
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6432
Practice Address - Country:US
Practice Address - Phone:515-512-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist