Provider Demographics
NPI:1346902376
Name:MANLEY, LARRY SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:SHANE
Last Name:MANLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:SHANE
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:540 TAMARRON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-8978
Mailing Address - Country:US
Mailing Address - Phone:479-366-4147
Mailing Address - Fax:
Practice Address - Street 1:117 S DIXIELAND ST STE B
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8658
Practice Address - Country:US
Practice Address - Phone:479-366-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor