Alexander Manzella, D.C.
Individual provider Active NPI Chiropractor · Bangor, WI
NPI 1982009239 · NPPES record last updated Oct 29, 2014
Key facts
- NPI
- 1982009239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5046-12 (WI)
- Practice address
- 1505 Commercial St
Bangor, WI 54614-8778 - Phone
- (608) 486-4899
- Fax
- (608) 486-4661
- NPI assigned
- Oct 29, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1505 Commercial St
Bangor, WI 54614-8778
Phone (608) 486-4899
PO Box
Suite 410
Bangor, WI 54614
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240830002277 | WI | Practitioner - Chiropractic | 5395284509 | Practice locations: Bangor, WI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthsource of Bangor S C | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5046-12 | WI | Yes |
Addresses
Primary practice location
1505 Commercial St
Bangor, WI 54614-8778
Mailing address
1505 Commercial St
P.O. Box 410
Bangor, WI 54614-8778
Phone (608) 486-4899
Other providers in Bangor, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.