Healthcare Provider Details

I. General information

NPI: 1578673299
Provider Name (Legal Business Name): MANCE CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EAST MAIN STREET
MORRISON IL
61270-2639
US

IV. Provider business mailing address

125 EAST MAIN STREET
MORRISON IL
61270-2639
US

V. Phone/Fax

Practice location:
  • Phone: 815-772-7641
  • Fax: 815-772-7642
Mailing address:
  • Phone: 815-772-7641
  • Fax: 815-772-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. GERALD LEE MANCE
Title or Position: PRESIDENT
Credential: DC
Phone: 815-772-7641