Provider Demographics
NPI:1144258864
Name:MANNEY, PHILIP L (BA, BS, DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:MANNEY
Suffix:
Gender:M
Credentials:BA, BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5345
Mailing Address - Country:US
Mailing Address - Phone:570-672-2564
Mailing Address - Fax:570-672-2564
Practice Address - Street 1:44 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5345
Practice Address - Country:US
Practice Address - Phone:570-644-2225
Practice Address - Fax:570-644-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003326L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011457280002Medicaid
PAMA 484133Medicare ID - Type Unspecified