Provider Demographics
NPI:1821497272
Name:MANRIQUE, ANTONIO FERNANDO III (DC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:FERNANDO
Last Name:MANRIQUE
Suffix:III
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:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1398
Mailing Address - Country:US
Mailing Address - Phone:787-402-5545
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA ESQ LOPEZ FLORES
Practice Address - Street 2:URB. PARADIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-402-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor