Provider Demographics
NPI:1972906477
Name:HEALTHSOURCE OF MANHATTAN, LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF MANHATTAN, LLC
Other - Org Name:PAQUETTE CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-587-8989
Mailing Address - Street 1:930 HAYES DR STE C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5721
Mailing Address - Country:US
Mailing Address - Phone:785-587-8989
Mailing Address - Fax:785-587-8069
Practice Address - Street 1:930 HAYES DR STE C
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5721
Practice Address - Country:US
Practice Address - Phone:785-587-8989
Practice Address - Fax:785-587-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105062305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization