MEDICARE: DR. WAYNE DOUGLAS MANTEL D.C.

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	B700	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457327926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE DOUGLAS MANTEL D.C.

Provider Business Mailing Address
First Line	:	3770 E DESERT INN RD
Second Line	:	SUITE 264
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3339
Country	:	US
Telephone Number	:	702-454-3775
Fax Number	:	702-454-7407

Provider Business Practice Location Address
First Line	:	3771 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3338
Country	:	US
Telephone Number	:	702-454-3775
Fax Number	:	702-454-7407

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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