Provider Demographics
NPI:1629155262
Name:MANN, CARL S (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:S
Last Name:MANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3541
Mailing Address - Country:US
Mailing Address - Phone:412-492-0102
Mailing Address - Fax:412-492-0104
Practice Address - Street 1:3865 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3541
Practice Address - Country:US
Practice Address - Phone:412-492-0102
Practice Address - Fax:412-492-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006041-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126187OtherS.W.I.F.CO
PA647659OtherUNITED HEALTHCARE
PA1012565OtherAMERICAN SPECIALTY HEALTH
PA647659OtherHIGHMARK
PA6820238OtherCIGNA
PA647659OtherHIGHMARK
PA647659Medicare ID - Type Unspecified