Healthcare Provider Details

I. General information

NPI: 1497970602
Provider Name (Legal Business Name): ALLEN M MANISON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 COLUMBIA 100 PKWY SUITE D
COLUMBIA MD
21045-2147
US

IV. Provider business mailing address

8835 COLUMBIA 100 PKWY SUITE D
COLUMBIA MD
21045-2147
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-3229
  • Fax: 410-964-9671
Mailing address:
  • Phone: 410-964-3229
  • Fax: 410-964-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC009254
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1898PT
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: