Provider Demographics
NPI:1457327926
Name:MANTEL, WAYNE DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DOUGLAS
Last Name:MANTEL
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 1:3770 E DESERT INN RD
Mailing Address - Street 2:SUITE 264
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3339
Mailing Address - Country:US
Mailing Address - Phone:702-454-3775
Mailing Address - Fax:702-454-7407
Practice Address - Street 1:3771 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3338
Practice Address - Country:US
Practice Address - Phone:702-454-3775
Practice Address - Fax:702-454-7407
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3602017Medicaid
NV3602017Medicaid
NV36664Medicare ID - Type Unspecified