=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376816595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISAAC STANFORD MANNING II D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2012
-----------------------------------------------------
Last Update Date | 02/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 W LAKE MANN DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32805-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-299-0006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 555784
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32855-5784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-625-3921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | CH10486
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------