Provider Demographics
NPI:1598988164
Name:DYER MANTONYA CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DYER MANTONYA CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANTONYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-522-5500
Mailing Address - Street 1:693 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1579
Mailing Address - Country:US
Mailing Address - Phone:740-522-5500
Mailing Address - Fax:740-522-5444
Practice Address - Street 1:693 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1579
Practice Address - Country:US
Practice Address - Phone:740-522-5500
Practice Address - Fax:740-522-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190089Medicaid
OH0112327Medicaid
OH2193906Medicaid
OH2609252Medicaid
OHU39664Medicare UPIN
OH0732852Medicare ID - Type Unspecified
OH9355481Medicare ID - Type UnspecifiedGROUP NUMBER
OH0112327Medicaid
OH2190089Medicaid
OH2193906Medicaid
OH4032442Medicare ID - Type Unspecified