Provider Demographics
NPI:1346248184
Name:AHNEN, MANFRED H (DC)
Entity Type:Individual
Prefix:DR
First Name:MANFRED
Middle Name:H
Last Name:AHNEN
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 1:2058 S DOBSON RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6454
Mailing Address - Country:US
Mailing Address - Phone:480-755-7777
Mailing Address - Fax:480-752-3281
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-755-7777
Practice Address - Fax:480-752-3281
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU64670Medicare UPIN
AZDC5682Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER