=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487882437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYCE E MCMANUS DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 STATE STREET
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-494-0515
-----------------------------------------------------
Fax | 203-453-2822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 STATE STREET
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-494-0515
-----------------------------------------------------
Fax | 203-453-2822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1805
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------