Provider Demographics
NPI:1497809495
Name:JERRY A MANTONYA
Entity Type:Organization
Organization Name:JERRY A MANTONYA
Other - Org Name:MANTONYA CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC OWNER-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANTONYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-366-6601
Mailing Address - Street 1:919 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2919
Mailing Address - Country:US
Mailing Address - Phone:740-366-6601
Mailing Address - Fax:740-366-6286
Practice Address - Street 1:919 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2919
Practice Address - Country:US
Practice Address - Phone:740-366-6601
Practice Address - Fax:740-366-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH451111N00000X
OH870111N00000X
OH3023111N00000X
OH3567111N00000X
OH3530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000160597OtherANTHEM BC BS
OH0112381Medicaid
OH000000160597OtherANTHEM BC BS
OH000000160597OtherANTHEM BC BS