Provider Demographics
NPI:1467455246
Name:MANOLOV, MANOL (DC)
Entity Type:Individual
Prefix:DR
First Name:MANOL
Middle Name:
Last Name:MANOLOV
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 1:115 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-2012
Mailing Address - Country:US
Mailing Address - Phone:317-828-0696
Mailing Address - Fax:
Practice Address - Street 1:6905 E 96TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4448
Practice Address - Country:US
Practice Address - Phone:317-577-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29075111N00000X
IN08002643A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002643AOtherINDIANA CHIROPRACTIC LICENSE
CADC29075OtherLICENSE
11360790OtherCAQH
V03807Medicare UPIN