MEDICARE: DR. NELSON MANE MD, DC

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	CH4968	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	ME137501	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83-1611860	OTHER		TAX ID
2	ME137501	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	592557391	OTHER	FL	TAX-ID NUMBER
5	CH4968	OTHER	FL	CHIROPRACTOR LICENSE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568520971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON MANE MD, DC

Provider Business Mailing Address
First Line	:	16124 BELLE MEADE BLVD
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3308
Country	:	US
Telephone Number	:	813-935-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST STE F
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6371
Country	:	US
Telephone Number	:	813-935-4744
Fax Number	:	813-931-1427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/04/2021

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Directions to “ DR. NELSON MANE MD, DC” Practice Location

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