MEDICARE: MANTONYA CHIROPRACTIC CENTER LLC

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1346600756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANTONYA CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	905 N 21ST STREET
Second Line	:	SUITE D
City	:	NEWARK
State	:	OH
Zip	:	43055-7251
Country	:	US
Telephone Number	:	740-366-6601
Fax Number	:	740-366-6286

Provider Business Practice Location Address
First Line	:	149 N HIGH ST
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-9669
Country	:	US
Telephone Number	:	740-928-7686
Fax Number	:	740-928-5585

Authorized Official
Title or Position	:	CLINIC OWNER
Name	:	GREGG ALLEN MANTONYA
Credential	:	D.C.
Telephone Number	:	740-366-6601

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	03/27/2020

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