Provider Demographics
NPI:1750570735
Name:DR. ROD J. MANADERO, DC, PC
Entity type:Organization
Organization Name:DR. ROD J. MANADERO, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANADERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-595-8433
Mailing Address - Street 1:727 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1507
Mailing Address - Country:US
Mailing Address - Phone:757-595-8433
Mailing Address - Fax:757-595-9004
Practice Address - Street 1:727 J CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1507
Practice Address - Country:US
Practice Address - Phone:757-595-8433
Practice Address - Fax:757-595-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556432261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10290Medicare PIN