Provider Demographics
NPI:1942504410
Name:MANNIS, JEFFREY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:MANNIS
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 1:1933 FARM ROAD 115
Mailing Address - Street 2:SIUTE B
Mailing Address - City:MT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-7434
Mailing Address - Country:US
Mailing Address - Phone:903-588-2237
Mailing Address - Fax:903-588-2239
Practice Address - Street 1:1933 FARM ROAD 115
Practice Address - Street 2:SIUTE B
Practice Address - City:MT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-7434
Practice Address - Country:US
Practice Address - Phone:903-588-2237
Practice Address - Fax:903-588-2239
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB145114Medicare PIN