Healthcare Provider Details

I. General information

NPI: 1821080276
Provider Name (Legal Business Name): DOUGLAS PATRICK MANFRA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E BONANZA RD STE.D
LAS VEGAS NV
89110-3365
US

IV. Provider business mailing address

1842 NAPOLEON DR
LAS VEGAS NV
89156-7184
US

V. Phone/Fax

Practice location:
  • Phone: 702-388-0599
  • Fax: 702-388-2877
Mailing address:
  • Phone: 702-432-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberB-291
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: