Provider Demographics
NPI:1730183666
Name:PARENTEAA, EMMANUEL VICTOR (DC)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:VICTOR
Last Name:PARENTEAA
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 1:1175 W STEELE LN
Mailing Address - Street 2:STE 4
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3553
Mailing Address - Country:US
Mailing Address - Phone:707-578-4156
Mailing Address - Fax:707-578-0723
Practice Address - Street 1:1175 W STEELE LN
Practice Address - Street 2:STE 4
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3553
Practice Address - Country:US
Practice Address - Phone:707-578-4156
Practice Address - Fax:707-578-0723
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0292180Medicare ID - Type Unspecified