Provider Demographics
NPI:1649456633
Name:MANKAMYER, KENNETH R (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:MANKAMYER
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 1:11349 NATIONAL PIKE
Mailing Address - Street 2:P.O. BOX 26
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-2015
Mailing Address - Country:US
Mailing Address - Phone:301-895-5100
Mailing Address - Fax:301-895-5468
Practice Address - Street 1:11349 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-2015
Practice Address - Country:US
Practice Address - Phone:301-895-5100
Practice Address - Fax:301-895-5468
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02031111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD066N942FMedicare PIN