Provider Demographics
NPI:1396946570
Name:JOHN MANCHIN II & JOHN MANCHIN III
Entity type:Organization
Organization Name:JOHN MANCHIN II & JOHN MANCHIN III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHIN
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:304-825-6554
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571-0029
Mailing Address - Country:US
Mailing Address - Phone:304-825-6554
Mailing Address - Fax:304-825-1371
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571
Practice Address - Country:US
Practice Address - Phone:304-825-6554
Practice Address - Fax:304-825-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034619000Medicaid
WV0034619000Medicaid
WV513865Medicare PIN
WV513865Medicare Oscar/Certification
WV9916641Medicare PIN