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General NPI Number Information
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NPI Number | 1073741534
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Entity Type | Individual
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Provider Name | MATTHEW E MANCUSO D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 571 HIGH ST SUITE 2
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City | WORTHINGTON
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State | OH
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Zip | 43085-4132
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Country | US
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Telephone | 614-396-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 KILDALE SQ S
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City | COLUMBUS
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State | OH
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Zip | 43229-1928
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Country | US
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Telephone | 614-597-8338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC4237
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License Number State | OH
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