Provider Demographics
NPI:1669132890
Name:MANTZ, BRENDA JEANETTE (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEANETTE
Last Name:MANTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-1815
Mailing Address - Country:US
Mailing Address - Phone:785-731-1126
Mailing Address - Fax:785-754-2212
Practice Address - Street 1:116 E 4TH ST
Practice Address - Street 2:
Practice Address - City:QUINTER
Practice Address - State:KS
Practice Address - Zip Code:67752-8402
Practice Address - Country:US
Practice Address - Phone:785-754-2212
Practice Address - Fax:785-754-2212
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor