Provider Demographics
NPI:1215944525
Name:MANNING, KATINA VENETIS (DC)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:VENETIS
Last Name:MANNING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3811
Mailing Address - Country:US
Mailing Address - Phone:781-934-5114
Mailing Address - Fax:781-934-9114
Practice Address - Street 1:178 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3811
Practice Address - Country:US
Practice Address - Phone:781-934-5114
Practice Address - Fax:781-934-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36235Medicare PIN