Healthcare Provider Details

I. General information

NPI: 1194550418
Provider Name (Legal Business Name): MANFREDI CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 S MISSION RD
FALLBROOK CA
92028-3202
US

IV. Provider business mailing address

41969 MARGARITA RD APT 40
TEMECULA CA
92591-2817
US

V. Phone/Fax

Practice location:
  • Phone: 818-512-2507
  • Fax:
Mailing address:
  • Phone: 818-512-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. VANESSA MANFREDI
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 818-512-2507