Provider Demographics
NPI:1558722637
Name:MANOR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MANOR CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKEIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-695-5001
Mailing Address - Street 1:PO BOX 24102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403
Mailing Address - Country:US
Mailing Address - Phone:912-695-5001
Mailing Address - Fax:844-695-5001
Practice Address - Street 1:3025 BULL ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2016
Practice Address - Country:US
Practice Address - Phone:912-695-5001
Practice Address - Fax:844-695-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty