Provider Demographics
NPI:1679687925
Name:KATINA MANNING
Entity Type:Organization
Organization Name:KATINA MANNING
Other - Org Name:WELLSPRING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:VENETIS
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-934-5114
Mailing Address - Street 1:178 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3811
Mailing Address - Country:US
Mailing Address - Phone:781-934-5114
Mailing Address - Fax:781-934-9114
Practice Address - Street 1:178 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3811
Practice Address - Country:US
Practice Address - Phone:781-934-5114
Practice Address - Fax:781-934-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36235Medicare ID - Type Unspecified