Provider Demographics
NPI:1700851201
Name:MANOVILL, THOMAS M (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:MANOVILL
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 1:2467 ENTERPRISE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1724
Mailing Address - Country:US
Mailing Address - Phone:727-799-2737
Mailing Address - Fax:727-791-0973
Practice Address - Street 1:2467 ENTERPRISE RD
Practice Address - Street 2:SUITE D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1724
Practice Address - Country:US
Practice Address - Phone:727-799-2737
Practice Address - Fax:727-791-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3815242Medicaid
FL3815242Medicaid
FLE8094Medicare ID - Type Unspecified