Provider Demographics
NPI:1225344724
Name:MANNINEN, ADAM JAMES (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:MANNINEN
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 1:1207 MICHIGAN ST
Mailing Address - Street 2:STE B
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-6608
Mailing Address - Country:US
Mailing Address - Phone:208-265-2225
Mailing Address - Fax:
Practice Address - Street 1:3508 LARAMIE DR STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2006
Practice Address - Country:US
Practice Address - Phone:989-387-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty