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General NPI Number Information
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NPI Number | 1164569562
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Entity Type | Organization
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Legal Business Name | JERRY A MANTONYA
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 149 N HIGH ST
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City | HEBRON
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State | OH
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Zip | 43025-9669
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Country | US
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Telephone | 740-928-7686
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Fax | 740-928-5585
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Provider Business Mailing Address
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Address Line | 149 N HIGH ST
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City | HEBRON
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State | OH
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Zip | 43025-9669
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Country | US
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Telephone | 740-928-7686
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Fax | 740-928-5585
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | JERRY A MANTONYA
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Credential | D.C.
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Telephone | 740-928-7686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 451
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License Number State | OH
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