MEDICARE: MANKAMYER CHIROPRACTIC AND REHABILITATION PC

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	DC008044L	PA
2	111N00000X	Chiropractor	S02031	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3119847	OTHER	MD	MAMSI
2	J527MA	OTHER	MD	BCBS

General Provider Information

NPI Number	:	1558317875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANKAMYER CHIROPRACTIC AND REHABILITATION PC

Provider Business Mailing Address
First Line	:	14689
Second Line	:	SUITE 2
City	:	OAKLAND
State	:	MD
Zip	:	21550
Country	:	US
Telephone Number	:	301-334-3220
Fax Number	:	301-334-3225

Provider Business Practice Location Address
First Line	:	14689 GARRETT HWY STE 2
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-4059
Country	:	US
Telephone Number	:	301-334-3220
Fax Number	:	301-334-3225

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KENNETH R MANKAMYER
Credential	:	DC
Telephone Number	:	301-334-3220

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/25/2023

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