Provider Demographics
NPI:1710084769
Name:MCMANUS, PETER WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:MCMANUS
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 1:2551 N CLARK ST STE 605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4578
Mailing Address - Country:US
Mailing Address - Phone:312-244-0413
Mailing Address - Fax:312-929-0260
Practice Address - Street 1:2551 N CLARK ST STE 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4578
Practice Address - Country:US
Practice Address - Phone:312-244-0413
Practice Address - Fax:312-929-0260
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor