Provider Demographics
NPI:1124209564
Name:MICHAEL MANLEY DC PC
Entity Type:Organization
Organization Name:MICHAEL MANLEY DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:712-546-5944
Mailing Address - Street 1:129 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3507
Mailing Address - Country:US
Mailing Address - Phone:712-546-5944
Mailing Address - Fax:
Practice Address - Street 1:129 1ST ST NW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3507
Practice Address - Country:US
Practice Address - Phone:712-546-5944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8626Medicare PIN