Provider Demographics
NPI:1295854818
Name:MANVILLE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MANVILLE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-524-1757
Mailing Address - Street 1:144 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1920
Mailing Address - Country:US
Mailing Address - Phone:608-524-1757
Mailing Address - Fax:
Practice Address - Street 1:144 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1920
Practice Address - Country:US
Practice Address - Phone:608-524-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3376012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========011OtherBCBS
WI=========011OtherBCBS
WIU64273Medicare UPIN