Provider Demographics
NPI:1790962181
Name:MANN MOBILE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MANN MOBILE CHIROPRACTIC, INC.
Other - Org Name:MANN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-376-8686
Mailing Address - Street 1:25 OLD 29 HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-7045
Mailing Address - Country:US
Mailing Address - Phone:706-376-8686
Mailing Address - Fax:
Practice Address - Street 1:25 OLD 29 HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-7045
Practice Address - Country:US
Practice Address - Phone:706-376-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJQPMedicare UPIN