Provider Demographics
NPI:1437218393
Name:MANTZ, RANDY J (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:J
Last Name:MANTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:MANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:P.O. BOX 33025
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-3025
Mailing Address - Country:US
Mailing Address - Phone:775-826-5800
Mailing Address - Fax:775-826-8466
Practice Address - Street 1:1895 PLUMAS ST
Practice Address - Street 2:STE 3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-826-5800
Practice Address - Fax:775-826-8466
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67293Medicare UPIN
NVVBFBSJMedicare PIN