Provider Demographics
NPI:1134289523
Name:MANELA, HOWARD IRWIN (DC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:IRWIN
Last Name:MANELA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:HOWARD
Other - Middle Name:IRWIN
Other - Last Name:MANELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1010 N CAMPBELL
Mailing Address - Street 2:STE 6
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067
Mailing Address - Country:US
Mailing Address - Phone:248-544-2400
Mailing Address - Fax:248-544-3079
Practice Address - Street 1:28817 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0915
Practice Address - Country:US
Practice Address - Phone:248-544-2400
Practice Address - Fax:248-544-3079
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM005424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1959191Medicaid
MI950F329160OtherBLUE CROSS BLUE SHIELD
MI1959191Medicaid
0F35288Medicare ID - Type Unspecified