Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5000 | AZ |
NPI | 1245379346 |
---|---|
Provider Name | Dr. Michael Lee Manning |
First Address | Gilbert, AZ 85234-6223 |
Second Address | Gilbert, AZ 85234-6223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |