Provider Demographics
NPI:1013981323
Name:MANLEY, KATHLEEN F (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:MANLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2328
Mailing Address - Country:US
Mailing Address - Phone:541-482-3362
Mailing Address - Fax:541-482-3362
Practice Address - Street 1:1745 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2328
Practice Address - Country:US
Practice Address - Phone:541-482-3362
Practice Address - Fax:541-482-3362
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR41665OtherWORKERS COMP
OR41665OtherWORKERS COMP
100432Medicare ID - Type Unspecified
ORR100432Medicare PIN