Provider Demographics
NPI:1952413668
Name:MANCUSO, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MANCUSO
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 1:16558 N 104TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2463
Mailing Address - Country:US
Mailing Address - Phone:480-510-3566
Mailing Address - Fax:480-556-1461
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-354-4370
Practice Address - Fax:602-354-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ8843OtherHEALTH NET
AZAZ0243590OtherBLUE CROSS BLUE SHIELD
AZZDC5012Medicare ID - Type Unspecified