Provider Demographics
NPI:1861486847
Name:MANZOLILLO, LUIGI (DC)
Entity Type:Individual
Prefix:
First Name:LUIGI
Middle Name:
Last Name:MANZOLILLO
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 1:280 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3007
Mailing Address - Country:US
Mailing Address - Phone:401-273-0046
Mailing Address - Fax:401-273-4100
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3007
Practice Address - Country:US
Practice Address - Phone:401-273-0046
Practice Address - Fax:401-273-4100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC00321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35440OtherBLUE CROSS
4400054OtherUNITED
U19015Medicare UPIN