Provider Demographics
NPI:1205996816
Name:MANUEL, GERALD W (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:MANUEL
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:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991
Mailing Address - Country:US
Mailing Address - Phone:772-223-1126
Mailing Address - Fax:772-288-3756
Practice Address - Street 1:3126 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990
Practice Address - Country:US
Practice Address - Phone:772-223-1126
Practice Address - Fax:772-288-3756
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69830Medicare UPIN
FL55616Medicare ID - Type Unspecified