Provider Demographics
NPI:1073576732
Name:MANNELLA, PHILLIP JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JOHN
Last Name:MANNELLA
Suffix:
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 1:1022 HILLCREST PKWY
Mailing Address - Street 2:STE 204
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4553
Mailing Address - Country:US
Mailing Address - Phone:478-374-1111
Mailing Address - Fax:478-374-1913
Practice Address - Street 1:5633 OAK ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-5638
Practice Address - Country:US
Practice Address - Phone:478-374-1111
Practice Address - Fax:478-374-1913
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor