Provider Demographics
NPI:1679197198
Name:MANNINEN PLLC
Entity Type:Organization
Organization Name:MANNINEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MANNINEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-548-7562
Mailing Address - Street 1:17754 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9404
Mailing Address - Country:US
Mailing Address - Phone:406-548-7562
Mailing Address - Fax:
Practice Address - Street 1:1207 MICHIGAN ST STE B
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-6608
Practice Address - Country:US
Practice Address - Phone:208-265-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty