Provider Demographics
NPI:1073032041
Name:MANLEY, RICHARD SHANNON III (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SHANNON
Last Name:MANLEY
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2036
Mailing Address - Country:US
Mailing Address - Phone:510-444-8494
Mailing Address - Fax:
Practice Address - Street 1:3530 GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2036
Practice Address - Country:US
Practice Address - Phone:510-444-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor