Provider Demographics
NPI:1467656389
Name:DR T SCOTT MANIS PC
Entity Type:Organization
Organization Name:DR T SCOTT MANIS PC
Other - Org Name:ODON FAMILY CHIRPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-636-8101
Mailing Address - Street 1:102 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1314
Mailing Address - Country:US
Mailing Address - Phone:812-636-8101
Mailing Address - Fax:812-636-7839
Practice Address - Street 1:102 S SPRING ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1314
Practice Address - Country:US
Practice Address - Phone:812-636-8101
Practice Address - Fax:812-636-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000370A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN216270Medicare ID - Type Unspecified