Provider Demographics
NPI:1912305525
Name:MANNS, BRYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:MANNS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 TOWNE LAKE HILLS SOUTH DR
Mailing Address - Street 2:06-203
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5350
Mailing Address - Country:US
Mailing Address - Phone:678-880-6616
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTAIN BROOK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9017
Practice Address - Country:US
Practice Address - Phone:678-880-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor