Provider Demographics
NPI:1831395722
Name:MANCUSO & SAMMUT CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MANCUSO & SAMMUT CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMMUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-484-3955
Mailing Address - Street 1:4125 MOHR AVE STE K
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4749
Mailing Address - Country:US
Mailing Address - Phone:925-484-3955
Mailing Address - Fax:925-484-3045
Practice Address - Street 1:4125 MOHR AVE STE K
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4749
Practice Address - Country:US
Practice Address - Phone:925-484-3955
Practice Address - Fax:925-484-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24792111N00000X
CADC24793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC024792OtherBC DR. MANCUSO
CADC024793OtherBC DR. SAMMUT
CA24792Medicare UPIN
CADC024793OtherBC DR. SAMMUT