Provider Demographics
NPI:1881038156
Name:MANFRE, JACQUELINE (DC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MANFRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-2134
Mailing Address - Country:US
Mailing Address - Phone:609-613-0715
Mailing Address - Fax:
Practice Address - Street 1:21 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-2134
Practice Address - Country:US
Practice Address - Phone:609-613-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00707100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor