Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR009849 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR009849 | GA |
NPI | 1255862207 |
---|---|
Provider Name | Jordan Manns |
First Address | Acworth, GA 30101-5674 |
Second Address | Acworth, GA 30101-5674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 19/11/2019 |