MEDICARE: DOUGLAS PATRICK MANFRA 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	111NX0800X	Orthopedic Chiropractor	B-291	NV

General Provider Information

NPI Number	:	1821080276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS PATRICK MANFRA D.C.

Provider Business Mailing Address
First Line	:	1842 NAPOLEON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7184
Country	:	US
Telephone Number	:	702-432-6123
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 E BONANZA RD
Second Line	:	STE.D
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3365
Country	:	US
Telephone Number	:	702-388-0599
Fax Number	:	702-388-2877

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	06/11/2008

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