Provider Demographics
NPI:1083449029
Name:MANS, MADELYN ANN (DIPL OM , LAC)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:ANN
Last Name:MANS
Suffix:
Gender:F
Credentials:DIPL OM , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40160 FAIRWAY III RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9511
Mailing Address - Country:US
Mailing Address - Phone:734-474-3381
Mailing Address - Fax:
Practice Address - Street 1:40160 FAIRWAY III RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-9511
Practice Address - Country:US
Practice Address - Phone:734-474-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty