Provider Demographics
NPI:1205919883
Name:MANZO, GENEVIEVE (DC)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 O ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6538
Mailing Address - Country:US
Mailing Address - Phone:916-739-8200
Mailing Address - Fax:916-739-8200
Practice Address - Street 1:3128 O ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6538
Practice Address - Country:US
Practice Address - Phone:916-739-8200
Practice Address - Fax:916-739-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0272620Medicare UPIN