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General NPI Number Information
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NPI Number | 1376928929
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Entity Type | Individual
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Provider Name | BRENT MANISCALCO D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 9841 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6100
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Country | US
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Telephone | 954-437-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 7240 SW 7TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-3825
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Country | US
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Telephone | 954-415-3621
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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 | CH11546
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License Number State | FL
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