Provider Demographics
NPI:1154470391
Name:MANTHOS, JAMES D (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:MANTHOS
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 1:21 RYDER PL STE 1000
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1200
Mailing Address - Country:US
Mailing Address - Phone:516-375-2399
Mailing Address - Fax:516-399-2227
Practice Address - Street 1:21 RYDER PL STE 1000
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1200
Practice Address - Country:US
Practice Address - Phone:516-399-2225
Practice Address - Fax:516-399-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009549-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2D791Medicare ID - Type UnspecifiedMEDICARE ID#