Provider Demographics
NPI:1851367908
Name:MANNINO, TIMOTHY GERARD (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GERARD
Last Name:MANNINO
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 1:7686 W RIDGE RD
Mailing Address - Street 2:PO BOX 369
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-0369
Mailing Address - Country:US
Mailing Address - Phone:814-474-5588
Mailing Address - Fax:814-474-5589
Practice Address - Street 1:7686 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1074
Practice Address - Country:US
Practice Address - Phone:814-474-5588
Practice Address - Fax:814-474-5589
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-4658-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU13673Medicare UPIN
PA656151Medicare ID - Type Unspecified