| Organization Name: | BROOKINGS HARBOR FAMILY PRACTICE CLINIC |
| NPI Number: | 1942415450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH MANUELE (D.O.) |
| Mailing Address: | 97825 Shopping Center Ave. Brookings |
| State: | OR US |
| Postal Code: | 97415 |
| Phone Number: | 5414692330 |
| Fax Number: | |
| NPI Enumeration Date: | 05/10/2007 |
| NPI Last Update Date: | 09/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 19106 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |