Provider Demographics
NPI:1497399216
Name:MANNS, MYLYNDA PATRICE-ANNE (DC)
Entity Type:Individual
Prefix:MRS
First Name:MYLYNDA
Middle Name:PATRICE-ANNE
Last Name:MANNS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MYLYNDA
Other - Middle Name:PATRICE-ANNE
Other - Last Name:CAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3969 S MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5674
Mailing Address - Country:US
Mailing Address - Phone:678-618-2198
Mailing Address - Fax:
Practice Address - Street 1:3969 S MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5674
Practice Address - Country:US
Practice Address - Phone:678-618-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor