Provider Demographics
NPI:1255451969
Name:DIZON, MANUEL MANALAD JR (DC)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:MANALAD
Last Name:DIZON
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SYCAMORE AVE
Mailing Address - Street 2:B14
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1775
Mailing Address - Country:US
Mailing Address - Phone:510-799-3760
Mailing Address - Fax:510-799-3744
Practice Address - Street 1:1500 SYCAMORE AVE
Practice Address - Street 2:B14
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1775
Practice Address - Country:US
Practice Address - Phone:510-799-3760
Practice Address - Fax:510-799-3744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor