MEDICARE: DR. JOSEPH MICHAEL MANCUSI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH4172	FL

General Provider Information

NPI Number	:	1245388438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL MANCUSI D.C.

Provider Business Mailing Address
First Line	:	7256 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6124
Country	:	US
Telephone Number	:	727-376-3445
Fax Number	:	727-376-3445

Provider Business Practice Location Address
First Line	:	7256 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6124
Country	:	US
Telephone Number	:	727-376-3445
Fax Number	:	727-376-3445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	11/05/2012

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