Provider Demographics
NPI:1063833903
Name:DONALD MANCHESTER CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:DONALD MANCHESTER CHIROPRACTIC PLLC
Other - Org Name:MANCHESTER CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, ND
Authorized Official - Phone:405-579-9844
Mailing Address - Street 1:231 E GRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7205
Mailing Address - Country:US
Mailing Address - Phone:405-579-9844
Mailing Address - Fax:405-364-4611
Practice Address - Street 1:231 E GRAY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7205
Practice Address - Country:US
Practice Address - Phone:405-579-9844
Practice Address - Fax:405-364-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA2549Medicare UPIN