Provider Demographics
NPI:1316294010
Name:PETER WILLIAM MCMANUS, D.C. LLC
Entity type:Organization
Organization Name:PETER WILLIAM MCMANUS, D.C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-244-0413
Mailing Address - Street 1:2551 N CLARK ST STE 605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4578
Mailing Address - Country:US
Mailing Address - Phone:312-244-0413
Mailing Address - Fax:
Practice Address - Street 1:2551 N CLARK ST STE 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4578
Practice Address - Country:US
Practice Address - Phone:312-244-0413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty