Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | B-291 | NV |
NPI | 1821080276 |
---|---|
Provider Name | Douglas Patrick Manfra |
First Address | Las Vegas, NV 89156-7184 |
Second Address | Las Vegas, NV 89110-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T67121 | (02) | NV |