Healthcare Provider Details

I. General information

NPI: 1033171160
Provider Name (Legal Business Name): MANNELLA CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PFEFFER RD SUITE5
EXPORT PA
15632-1934
US

IV. Provider business mailing address

105 PFEFFER RD SUITE 5
EXPORT PA
15632-1934
US

V. Phone/Fax

Practice location:
  • Phone: 724-325-5500
  • Fax: 724-733-0419
Mailing address:
  • Phone: 724-325-5500
  • Fax: 724-733-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008809
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008929
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3889856
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA HMO
# 2
Identifier7805446
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA PPO
# 3
Identifier1738415
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BCBS
# 4
Identifier6978384
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA

VIII. Authorized Official

Name: DR. LEANNE MANNELLA
Title or Position: OFFICE MANAGER
Credential: CHIROPRACTOR
Phone: 724-325-5500