Provider Demographics
NPI:1720421027
Name:MANIRE, JOHN THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:MANIRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1169 EASTERN PKWY STE 2358
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1415
Mailing Address - Country:US
Mailing Address - Phone:502-890-9979
Mailing Address - Fax:844-521-8730
Practice Address - Street 1:1169 EASTERN PKWY STE 2358
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-890-9979
Practice Address - Fax:844-521-8730
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004524A207Q00000X, 207Q00000X
KY04003207Q00000X
PAOS017424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02004524AOtherPLA IN MEDICAL LICENSING AGENCY
KY04003OtherKBML
18708OtherAMERICAN OSTEOPATHIC ASSOCIATION BOARD CERTIFICATION IN FAMILY MEDICINE/OMT
KYFM6501678OtherDEA