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General NPI Number Information
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NPI Number | 1558486175
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Entity Type | Individual
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Provider Name | MATTHEW J MANNINO D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 1549 N BURK ST STE100
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City | GILBERT
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State | AZ
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Zip | 85234-2483
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Country | US
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Telephone | 480-497-2642
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Fax | 480-497-1863
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Provider Business Mailing Address
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Address Line | 2373 E BASELINE RD STE100
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City | GILBERT
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State | AZ
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Zip | 85234-2477
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Country | US
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Telephone | 480-497-2642
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Fax | 480-497-1863
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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 | 4490
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License Number State | AZ
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