Provider Demographics
NPI:1881864569
Name:MANNING, JERRY RAY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RAY
Last Name:MANNING
Suffix:JR
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 1:4705 CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4103
Mailing Address - Country:US
Mailing Address - Phone:563-884-5810
Mailing Address - Fax:563-884-5470
Practice Address - Street 1:1055 PINEY FOREST RD
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4154
Practice Address - Country:US
Practice Address - Phone:434-836-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13241111N00000X
VA0104556602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05545OtherGROUP PTAN
VA1881864569Medicaid
6083240001Medicare NSC
C05545OtherGROUP PTAN