Provider Demographics
NPI:1740835214
Name:MANAHILOVA, IOANA
Entity type:Individual
Prefix:
First Name:IOANA
Middle Name:
Last Name:MANAHILOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 GROVE DR APT 408
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1838
Mailing Address - Country:US
Mailing Address - Phone:224-595-5704
Mailing Address - Fax:
Practice Address - Street 1:675 GROVE DR APT 408
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1838
Practice Address - Country:US
Practice Address - Phone:224-595-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2022-05-02
Deactivation Date:2022-03-29
Deactivation Code:
Reactivation Date:2022-04-26
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL038013845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician