Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1454 | OH |
NPI | 1003818352 |
---|---|
Provider Name | Dr. Peter J. Manz |
First Address | Columbus, OH 43229-1004 |
Second Address | Columbus, OH 43229-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 12/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0794501 | (05) | OH |
U39980 | (02) | OH |