Provider Demographics
NPI:1568520971
Name:MANE, NELSON (MD, DC)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:MANE
Suffix:
Gender:M
Credentials:MD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16124 BELLE MEADE BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3308
Mailing Address - Country:US
Mailing Address - Phone:813-935-4744
Mailing Address - Fax:
Practice Address - Street 1:2901 W SAINT ISABEL ST STE F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6371
Practice Address - Country:US
Practice Address - Phone:813-935-4744
Practice Address - Fax:813-931-1427
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4968111N00000X
390200000X
FLME137501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
83-1611860OtherTAX ID
FLME137501OtherMEDICAL LICENSE
FL380646400Medicaid
FL592557391OtherTAX-ID NUMBER
FLCH4968OtherCHIROPRACTOR LICENSE