Provider Demographics
NPI:1023525243
Name:MCMANIS, MANDY MARLENE JOBE (DC)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:MARLENE JOBE
Last Name:MCMANIS
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 1:1627 SYLVIA ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2563
Mailing Address - Country:US
Mailing Address - Phone:510-600-3466
Mailing Address - Fax:
Practice Address - Street 1:22316 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4007
Practice Address - Country:US
Practice Address - Phone:510-899-1432
Practice Address - Fax:510-889-1448
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33787OtherCHIROPRACTIC LICENSE NUMBER