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General NPI Number Information
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NPI Number | 1255862207
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Entity Type | Individual
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Provider Name | JORDAN MANNS
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 3969 S MAIN ST STE 150
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City | ACWORTH
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State | GA
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Zip | 30101-5674
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Country | US
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Telephone | 678-618-2198
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Fax |
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Provider Business Mailing Address
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Address Line | 3969 S MAIN ST STE 150
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City | ACWORTH
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State | GA
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Zip | 30101-5674
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Country | US
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Telephone | 678-618-2198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIR009849
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009849
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License Number State | GA
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