Provider Demographics
NPI:1619033305
Name:MANLEY, JEFFERY EARL (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:EARL
Last Name:MANLEY
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 PARK SPRINGS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1596
Mailing Address - Country:US
Mailing Address - Phone:817-784-2330
Mailing Address - Fax:817-330-0052
Practice Address - Street 1:4602 PARK SPRINGS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-784-2330
Practice Address - Fax:817-330-0052
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4480111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001349201Medicaid
TXT14576Medicare UPIN
TX001349201Medicaid
TX601766Medicare ID - Type UnspecifiedMEDICARE IDENTIFACATION N