Provider Demographics
NPI:1366826372
Name:MCMANUS, CHET
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:MCMANUS
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 1:2908 E 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4034
Mailing Address - Country:US
Mailing Address - Phone:605-336-2638
Mailing Address - Fax:605-334-3500
Practice Address - Street 1:2908 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103
Practice Address - Country:US
Practice Address - Phone:605-336-2638
Practice Address - Fax:605-334-4500
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1018363A00000X
MN12284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2010887Medicaid
SDS110275OtherSD MEDICARE