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General NPI Number Information
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NPI Number | 1912554692
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Entity Type | Individual
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Provider Name | MICHAEL JARED MANNS DC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 657 NE HOOD AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7328
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Country | US
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Telephone | 503-912-1156
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Fax | 971-292-2932
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Provider Business Mailing Address
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Address Line | 5920 BURMA RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3240
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Country | US
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Telephone | 971-330-8017
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6015
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License Number State | OR
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