MEDICARE: DR. BENJAMIN A MANUEL 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	DC27813	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0278130	OTHER	CA	PROVIDER NUMBER
2	DC27813	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1437239837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN A MANUEL D.C.

Provider Business Mailing Address
First Line	:	1155 UNIVERSITY DR
Second Line	:	SUITE ONE
City	:	MENLO PARK
State	:	CA
Zip	:	94025-4431
Country	:	US
Telephone Number	:	650-326-5927
Fax Number	:	650-326-5929

Provider Business Practice Location Address
First Line	:	1155 UNIVERSITY DR
Second Line	:	SUITE ONE
City	:	MENLO PARK
State	:	CA
Zip	:	94025-4431
Country	:	US
Telephone Number	:	650-326-5927
Fax Number	:	650-326-5929

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/09/2007

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