MEDICARE: MANA CHIROPRACTIC P.S.

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	CH00033920	WA
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1518042399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANA CHIROPRACTIC P.S.

Provider Business Mailing Address
First Line	:	412 GIRARD ST.
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4004
Country	:	US
Telephone Number	:	360-734-9525
Fax Number	:	360-734-9505

Provider Business Practice Location Address
First Line	:	412 GIRARD ST.
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4004
Country	:	US
Telephone Number	:	360-734-9525
Fax Number	:	360-734-9505

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DYLAN SEMU
Credential	:	D.C.
Telephone Number	:	360-734-9525

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/03/2023

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