Provider Demographics
NPI:1437349743
Name:MANNING, MARK R (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:MANNING
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 1:3023 QUENTIN ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-627-1127
Mailing Address - Fax:718-382-1153
Practice Address - Street 1:3023 QUENTIN ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-627-1127
Practice Address - Fax:718-382-1153
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003527-1111NN1001X
NYX2142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX 2142OtherNEW YORK STATE