Provider Demographics
NPI:1326501875
Name:MANN, JARED MICHAEL
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:MANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 A 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4723
Mailing Address - Country:US
Mailing Address - Phone:701-368-4380
Mailing Address - Fax:
Practice Address - Street 1:721 A 1ST AVE S
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4723
Practice Address - Country:US
Practice Address - Phone:701-368-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor