Provider Demographics
NPI:1043896152
Name:MANZANO, RHODEL MATTHEW (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:RHODEL
Middle Name:MATTHEW
Last Name:MANZANO
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23949 RUSTICO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1559
Mailing Address - Country:US
Mailing Address - Phone:661-877-0429
Mailing Address - Fax:
Practice Address - Street 1:25000 AVENUE STANFORD STE 161
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-4594
Practice Address - Country:US
Practice Address - Phone:661-753-3090
Practice Address - Fax:833-563-2545
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty