Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X2142 | NY |
N | 111NN1001X | Nutrition | 003527-1 | NY |
NPI | 1437349743 |
---|---|
Provider Name | Dr. Mark R Manning |
First Address | Brooklyn, NY 11234 |
Second Address | Brooklyn, NY 11234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 22/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X 2142 | NEW YORK STATE (01) | NY |