MEDICARE: SKYLINE CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1235076555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1412 YELM AVE E STE C101
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-8328
Country	:	US
Telephone Number	:	850-420-7643
Fax Number	:	877-537-1160

Provider Business Practice Location Address
First Line	:	1412 YELM AVE E STE C101
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-8328
Country	:	US
Telephone Number	:	850-420-7643
Fax Number	:	877-537-1160

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS MANZANARES
Credential	:	DC
Telephone Number	:	850-420-7643

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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