Provider Demographics
NPI:1851726723
Name:THE MANIS GROUP
Entity Type:Organization
Organization Name:THE MANIS GROUP
Other - Org Name:PERFORMANCE HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-230-1621
Mailing Address - Street 1:119 CHESTERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6362
Mailing Address - Country:US
Mailing Address - Phone:214-230-1621
Mailing Address - Fax:972-935-0930
Practice Address - Street 1:1601 N HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7812
Practice Address - Country:US
Practice Address - Phone:214-230-1621
Practice Address - Fax:972-935-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
TX6118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215360490OtherNPPES, NPI
1104817899OtherNPPES, NPI
1104817899OtherNPPES, NPI
C06038121Medicare Oscar/Certification