Provider Demographics
NPI:1053498428
Name:MANTEY, HEATHER NOELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NOELLE
Last Name:MANTEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4725
Mailing Address - Country:US
Mailing Address - Phone:847-475-4960
Mailing Address - Fax:847-475-4966
Practice Address - Street 1:1318 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4725
Practice Address - Country:US
Practice Address - Phone:847-475-4960
Practice Address - Fax:847-475-4966
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634925OtherBCBS PROVIDER #
IL210855Medicare ID - Type UnspecifiedGROUP #
ILK14323Medicare PIN