Provider Demographics
NPI:1366525289
Name:MANZA, JOSEPH M (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MANZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 METRO PARK
Mailing Address - Street 2:STE 6
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2653
Mailing Address - Country:US
Mailing Address - Phone:585-544-3759
Mailing Address - Fax:585-544-3884
Practice Address - Street 1:144 METRO PARK
Practice Address - Street 2:STE 6
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2653
Practice Address - Country:US
Practice Address - Phone:585-544-3759
Practice Address - Fax:585-544-3884
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0694Medicare ID - Type Unspecified