MEDICARE: MS. HEIDI MARIAN MANNING LAC., LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	157589	OR

General Provider Information

NPI Number	:	1053620435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI MARIAN MANNING LAC., LMT

Provider Business Mailing Address
First Line	:	PO BOX 453
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-0453
Country	:	US
Telephone Number	:	541-992-5175
Fax Number	:	866-456-0314

Provider Business Practice Location Address
First Line	:	35170 BROOTEN RD
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8036
Country	:	US
Telephone Number	:	541-992-5175
Fax Number	:	503-483-1116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	01/18/2021

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