Provider Demographics
NPI:1497864367
Name:MANASSON, DOMINIQUE (DC)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:MANASSON
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 1:1445 DONLON ST STE 15
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5640
Mailing Address - Country:US
Mailing Address - Phone:805-642-8788
Mailing Address - Fax:805-642-8788
Practice Address - Street 1:1445 DONLON ST STE 15
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5640
Practice Address - Country:US
Practice Address - Phone:805-642-8788
Practice Address - Fax:805-642-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12217Medicare ID - Type Unspecified