Healthcare Provider Details

I. General information

NPI: 1346600756
Provider Name (Legal Business Name): MANTONYA CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 N HIGH ST
HEBRON OH
43025-9669
US

IV. Provider business mailing address

905 N 21ST STREET SUITE D
NEWARK OH
43055-7251
US

V. Phone/Fax

Practice location:
  • Phone: 740-928-7686
  • Fax: 740-928-5585
Mailing address:
  • Phone: 740-366-6601
  • Fax: 740-366-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGG ALLEN MANTONYA
Title or Position: CLINIC OWNER
Credential: D.C.
Phone: 740-366-6601