Provider Demographics
NPI:1972364883
Name:MANZANILLA, MARIE CARITAS CIAR (LMT, CLT)
Entity Type:Individual
Prefix:
First Name:MARIE CARITAS
Middle Name:CIAR
Last Name:MANZANILLA
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:MANZANILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, CLT
Mailing Address - Street 1:150 E HURON ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2948
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2948
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227017488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist