Provider Demographics
NPI:1457432445
Name:MANNA FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MANNA FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-233-9000
Mailing Address - Street 1:310 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4268
Mailing Address - Country:US
Mailing Address - Phone:706-233-9000
Mailing Address - Fax:706-233-9510
Practice Address - Street 1:310 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4268
Practice Address - Country:US
Practice Address - Phone:706-233-9000
Practice Address - Fax:706-233-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU59926Medicare UPIN
GA35ZCDFNMedicare ID - Type UnspecifiedMEDICARE