Provider Demographics
NPI:1154109361
Name:MANCABELLI, PAYTON (DC)
Entity type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:
Last Name:MANCABELLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 GHENT RD STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3351
Mailing Address - Country:US
Mailing Address - Phone:330-223-5977
Mailing Address - Fax:
Practice Address - Street 1:55 GHENT RD STE C
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3351
Practice Address - Country:US
Practice Address - Phone:330-223-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor