Provider Demographics
NPI:1558486373
Name:DR RHONDA L MANTIN DC PA
Entity Type:Organization
Organization Name:DR RHONDA L MANTIN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-417-9355
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:STE. 109
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7209
Mailing Address - Country:US
Mailing Address - Phone:561-417-9355
Mailing Address - Fax:561-417-9488
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:STE. 109
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-417-9355
Practice Address - Fax:561-417-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO4970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0004970Medicare UPIN
FL70668Medicare ID - Type UnspecifiedMEDICARE NUMBER