Provider Demographics
NPI:1740389725
Name:MANNIS CHIROPRACTIC,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MANNIS CHIROPRACTIC,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OTIS
Authorized Official - Last Name:MANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-769-5868
Mailing Address - Street 1:1337 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8418
Mailing Address - Country:US
Mailing Address - Phone:951-788-1651
Mailing Address - Fax:
Practice Address - Street 1:10400 BEAUMONT AVE
Practice Address - Street 2:SUTIE E
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223-4432
Practice Address - Country:US
Practice Address - Phone:951-769-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty