Provider Demographics
NPI:1649963331
Name:MANNEY, JONATHON
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:MANNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2730
Mailing Address - Country:US
Mailing Address - Phone:217-809-1699
Mailing Address - Fax:
Practice Address - Street 1:1524 W FOREST AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2730
Practice Address - Country:US
Practice Address - Phone:217-809-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)