Provider Demographics
NPI:1760493795
Name:MANESS, JEFFERY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JAMES
Last Name:MANESS
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:WEST CONCORD
Mailing Address - State:MN
Mailing Address - Zip Code:55985-0256
Mailing Address - Country:US
Mailing Address - Phone:507-527-2201
Mailing Address - Fax:507-527-2202
Practice Address - Street 1:302 WEST MAIN
Practice Address - Street 2:
Practice Address - City:WEST CONCORD
Practice Address - State:MN
Practice Address - Zip Code:55985
Practice Address - Country:US
Practice Address - Phone:507-527-2201
Practice Address - Fax:507-527-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46263Medicare UPIN