HEALTHSOURCE OF BANGOR S C (NPI# 1912167057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912167057 |
| Entity Type | Organization |
| Organization Name | HEALTHSOURCE OF BANGOR S C |
| Practice Address |
1505 Commercial St Bangor WI 54614-0410 |
| Mailing Address |
Po Box 410 Bangor WI 54614-0410 |
| Practice Telephone | 6084864899 |
| Practice Fax Number | 6084864661 |
| Mailing Telephone | 6084864899 |
| Mailing Fax Number | 6084864661 |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2008-06-12 |
| Authorized Official Name | DR. JACK ANTHONY MANZELLA (DOCTOR OF CHIROPRACTIC) |
| Authorized Official Telephone | 6084864899 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 2555 | WI | Chiropractic Providers |
| Street Address |
1505 COMMERCIAL ST |
| City | BANGOR |
| State | WI |
| Zip Code | 54614-0410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982009239 | Alexander Manzella | Chiropractor | 1505 Commercial St, Bangor, WI 54614-8778 | 2014-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174652291 | Jack Anthony Manzella | Chiropractor | 1505 Commercial St., Bangor Family Chiropractic, Bangor, WI 54614 | 2007-03-05 |
| 1861629057 | School District of Bangor | Local Education Agency (LEA) | 700 10th Ave S, Bangor, WI 54614-8710 | 2009-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1760096564 | Colby Thomas Toth | Specialist/Technologist | 83 Palmer Rd, Bangor, PA 18013-9204 | 2020-08-31 |
| 1861002750 | Alyssa Paige Oliver | Counselor | 689 Odlin Rd, Bangor, ME 04401-6709 | 2020-08-05 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1073139465 | Jaclyn Kimberly Foraker | Nurse Practitioner | 885 Union St Ste 215, Bangor, ME 04401-3092 | 2020-06-22 |
| 1124644950 | Robert Thibeault Brookings | Dentist | 39 Grove Street, Bangor, ME 04401-5309 | 2020-06-17 |
| 1548884323 | A&m Home Care Corp | Technician | 84 Hammond St Ste 441, Bangor, ME 04401-4915 | 2020-06-08 |
| 1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
| 1619590247 | Meghan Chenausky | Nurse Practitioner | Pchcenter, 1012 Union Street, Bangor, ME 04401-3060 | 2020-05-18 |
| 1528680261 | Adam Ketchum | Technician | 56 Smith St Apt 2, Bangor, ME 04401-4715 | 2020-05-16 |
| Find all providers in BANGOR | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174096309 | Vanidestine Chiropractic, Inc | Chiropractor | 336 Mount Hope Ave Ste 11, Bangor, ME 04401-4236 | 2019-01-10 |
| 1205306503 | Daniel Luigi Comunale | Chiropractor | 622 Fox Gap Rd, Bangor, PA 18013-5833 | 2018-11-29 |
| 1699264143 | My Life Well Adjusted LLC | Chiropractor | 268 State St Ste 1, Bangor, ME 04401-5417 | 2018-05-09 |
| 1598079873 | Nathan Bryan Roberts | Chiropractor | 125 W Monroe St, Bangor, MI 49013-1332 | 2010-07-29 |
| 1558699314 | Rickie Lane Ames | Chiropractor | 804 Stillwater Ave, Bangor, ME 04401-3614 | 2009-12-05 |
| 1174652291 | Jack Anthony Manzella | Chiropractor | 1505 Commercial St., Bangor Family Chiropractic, Bangor, WI 54614 | 2007-03-05 |
| 1154469047 | Richard J Thomas | Chiropractor | 804 Stillwater Avenue, Bangor, ME 04401 | 2007-02-02 |
| 1164438917 | Robin William Gooden | Chiropractor | 16 Penn Plz, Ste 22, Bangor, ME 04401-3620 | 2006-08-01 |
| 1912911371 | Richard J Weaver | Chiropractor | 83 Bangor Junction Road, Blue Valley Plaza, Bangor, PA 18013 | 2006-07-28 |
| 1841219029 | Richard M. Bruns | Chiropractor | 371 Union St, Bangor, ME 04401-4504 | 2006-07-19 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.