Provider Demographics
NPI:1578673299
Name:MANCE CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:MANCE CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-772-7641
Mailing Address - Street 1:125 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-2639
Mailing Address - Country:US
Mailing Address - Phone:815-772-7641
Mailing Address - Fax:815-772-7642
Practice Address - Street 1:125 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2639
Practice Address - Country:US
Practice Address - Phone:815-772-7641
Practice Address - Fax:815-772-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720265572OtherNPI
IL612270Medicaid
IL9882009OtherBLUE CROSS BLUE SHIELD
T37240Medicare UPIN
IL612270Medicare ID - Type Unspecified