Provider Demographics
NPI:1215169891
Name:MANN, SEAN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:MANN
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 1:1725 SIDEWINDER DR
Mailing Address - Street 2:SUITE 1011/ P.O. BOX 188
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7468
Mailing Address - Country:US
Mailing Address - Phone:435-655-0420
Mailing Address - Fax:
Practice Address - Street 1:1725 SIDEWINDER DR
Practice Address - Street 2:SUITE 1011
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7468
Practice Address - Country:US
Practice Address - Phone:435-655-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27125111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology