Provider Demographics
NPI:1104957455
Name:MANFRE, VINCENT S (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:S
Last Name:MANFRE
Suffix:
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 1:520 W PALMDALE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4229
Mailing Address - Country:US
Mailing Address - Phone:661-274-4141
Mailing Address - Fax:661-274-4526
Practice Address - Street 1:520 W PALMDALE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4229
Practice Address - Country:US
Practice Address - Phone:661-274-4141
Practice Address - Fax:661-274-4526
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor