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General NPI Number Information
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NPI Number | 1316294010
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Entity Type | Organization
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Legal Business Name | PETER WILLIAM MCMANUS, D.C. LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 2551 N CLARK ST STE 605
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City | CHICAGO
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State | IL
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Zip | 60614-4578
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Country | US
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Telephone | 312-244-0413
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 N CLARK ST STE 605
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City | CHICAGO
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State | IL
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Zip | 60614-4578
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Country | US
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Telephone | 312-244-0413
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER OF LLC
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Name | DR. PETER WILLIAM MCMANUS
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Credential | D.C.
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Telephone | 312-244-0413
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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 | 038011427
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License Number State | IL
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