Provider Demographics
NPI:1558317875
Name:MANKAMYER CHIROPRACTIC AND REHABILITATION PC
Entity type:Organization
Organization Name:MANKAMYER CHIROPRACTIC AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANKAMYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-334-3220
Mailing Address - Street 1:14689
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-334-3220
Mailing Address - Fax:301-334-3225
Practice Address - Street 1:14689 GARRETT HWY STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4059
Practice Address - Country:US
Practice Address - Phone:301-334-3220
Practice Address - Fax:301-334-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008044L111N00000X
MDS02031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3119847OtherMAMSI
MDJ527MAOtherBCBS
MD066N942FMedicare ID - Type Unspecified
U87401Medicare UPIN