Provider Demographics
NPI:1992837835
Name:MANTO, MICHELLE (DACM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MANTO
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MAIN ST # 6
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1608
Mailing Address - Country:US
Mailing Address - Phone:413-464-1910
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN ST # 6
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1608
Practice Address - Country:US
Practice Address - Phone:413-464-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224499171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist