Provider Demographics
NPI:1861514317
Name:MANRIQUEZ, ANTONIO M JR (DC)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:M
Last Name:MANRIQUEZ
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:85690 CALLE LIMON
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-2628
Mailing Address - Country:US
Mailing Address - Phone:760-398-2047
Mailing Address - Fax:
Practice Address - Street 1:67555 E PALM CANYON DR
Practice Address - Street 2:C-108
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5467
Practice Address - Country:US
Practice Address - Phone:760-321-1453
Practice Address - Fax:760-324-6656
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-23308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor