Provider Demographics
NPI:1821080276
Name:MANFRA, DOUGLAS PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PATRICK
Last Name:MANFRA
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 1:1842 NAPOLEON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-7184
Mailing Address - Country:US
Mailing Address - Phone:702-432-6123
Mailing Address - Fax:
Practice Address - Street 1:4500 E BONANZA RD
Practice Address - Street 2:STE.D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3365
Practice Address - Country:US
Practice Address - Phone:702-388-0599
Practice Address - Fax:702-388-2877
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-291111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67121Medicare UPIN
NV21080276Medicare PIN