Provider Demographics
NPI:1740299296
Name:MCMAHON MANNING, KATHLEEN M (DC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MCMAHON MANNING
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 1:338 S COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4526
Mailing Address - Country:US
Mailing Address - Phone:630-673-4298
Mailing Address - Fax:
Practice Address - Street 1:338 S COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4526
Practice Address - Country:US
Practice Address - Phone:630-673-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU77476Medicare UPIN
ILL73416Medicare ID - Type UnspecifiedMEDICARE NUMBER