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General NPI Number Information
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NPI Number | 1932404316
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Entity Type | Organization
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Legal Business Name | MANCUSO CHIRO CENTER LLC
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 18205 N 51ST AVE SUITE 113
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City | GLENDALE
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State | AZ
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Zip | 85308-1490
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Country | US
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Telephone | 602-354-4370
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Fax | 602-354-4695
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Provider Business Mailing Address
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Address Line | 18205 N 51ST AVE SUITE 113
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City | GLENDALE
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State | AZ
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Zip | 85308-1490
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Country | US
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Telephone | 602-354-4370
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Fax | 602-354-4695
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID ANTHONY MANCUSO
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Credential | DC
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Telephone | 480-510-3566
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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 | 5012
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License Number State | AZ
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