Provider Demographics
NPI:1144356486
Name:MANSON, KIRK EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:EDWARD
Last Name:MANSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE STE 24
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2631
Mailing Address - Country:US
Mailing Address - Phone:505-884-0044
Mailing Address - Fax:505-881-7393
Practice Address - Street 1:717 ENCINO PL NE STE 24
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2631
Practice Address - Country:US
Practice Address - Phone:505-884-0044
Practice Address - Fax:505-881-7393
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1126111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor