Provider Demographics
NPI:1497970602
Name:MANISON, ALLEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:MANISON
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 1:8835 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2147
Mailing Address - Country:US
Mailing Address - Phone:410-964-3229
Mailing Address - Fax:410-964-9671
Practice Address - Street 1:8835 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2147
Practice Address - Country:US
Practice Address - Phone:410-964-3229
Practice Address - Fax:410-964-9671
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009254111NS0005X
MD1898PT111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD085NMedicare ID - Type Unspecified
075182Medicare UPIN