Provider Demographics
NPI:1114213279
Name:VANNATTA, MANDY J (DC)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:J
Last Name:VANNATTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-2833
Mailing Address - Country:US
Mailing Address - Phone:608-732-5545
Mailing Address - Fax:
Practice Address - Street 1:1250 BUSINESS US-151
Practice Address - Street 2:STE H
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9269
Practice Address - Country:US
Practice Address - Phone:608-732-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4756-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor