Provider Demographics
NPI:1932321775
Name:JEFF MANLEY DC PC
Entity Type:Organization
Organization Name:JEFF MANLEY DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-784-2330
Mailing Address - Street 1:2501 E MAYFIELD RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2807
Mailing Address - Country:US
Mailing Address - Phone:817-784-2330
Mailing Address - Fax:817-784-2320
Practice Address - Street 1:2501 E MAYFIELD RD
Practice Address - Street 2:SUITE 123
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2807
Practice Address - Country:US
Practice Address - Phone:817-784-2330
Practice Address - Fax:817-784-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4480111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601766OtherBLUE CROSS BLUE SHEILD
TX601766Medicare ID - Type Unspecified
TXT14576Medicare UPIN