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General NPI Number Information
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NPI Number | 1952413668
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Entity Type | Individual
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Provider Name | DAVID A MANCUSO D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/09/2012
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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 | 16558 N 104TH WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-2463
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Country | US
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Telephone | 480-510-3566
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Fax | 480-556-1461
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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 | 5012
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License Number State | AZ
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