Provider Demographics
NPI:1023090933
Name:MANIS, TIMOTHY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:MANIS
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 1:1508 N THORNTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8516
Mailing Address - Country:US
Mailing Address - Phone:706-279-9295
Mailing Address - Fax:706-279-9296
Practice Address - Street 1:1508 N THORNTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8516
Practice Address - Country:US
Practice Address - Phone:706-279-9295
Practice Address - Fax:706-279-9296
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU76873Medicare UPIN
IN200227590AMedicaid
IN000000297823OtherANTHEM PIN #
INU76873Medicare UPIN