Provider Demographics
NPI:1982009239
Name:MANZELLA, ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MANZELLA
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 1:1505 COMMERCIAL ST
Mailing Address - Street 2:P.O. BOX 410
Mailing Address - City:BANGOR
Mailing Address - State:WI
Mailing Address - Zip Code:54614-8778
Mailing Address - Country:US
Mailing Address - Phone:608-486-4899
Mailing Address - Fax:608-486-4661
Practice Address - Street 1:1505 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:WI
Practice Address - Zip Code:54614-8778
Practice Address - Country:US
Practice Address - Phone:608-486-4899
Practice Address - Fax:608-486-4661
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5046-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor