Provider Demographics
NPI:1912554692
Name:MANNS, MICHAEL JARED (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JARED
Last Name:MANNS
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 1:5920 BURMA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3240
Mailing Address - Country:US
Mailing Address - Phone:971-330-8017
Mailing Address - Fax:
Practice Address - Street 1:657 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7328
Practice Address - Country:US
Practice Address - Phone:503-912-1156
Practice Address - Fax:971-292-2932
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor