Healthcare Provider Details

I. General information

NPI: 1740389725
Provider Name (Legal Business Name): MANNIS CHIROPRACTIC,A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BEAUMONT AVE SUTIE E
CHERRY VALLEY CA
92223-4432
US

IV. Provider business mailing address

1337 SUTHERLAND DR
RIVERSIDE CA
92507-8418
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-5862
  • Fax:
Mailing address:
  • Phone: 951-788-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29999
License Number StateCA

VIII. Authorized Official

Name: DR. VICTOR OTIS MANNIS
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 951-769-5868