Provider Demographics
NPI:1316954803
Name:MANNEY, RUSSELL E III (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:E
Last Name:MANNEY
Suffix:III
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 1:1516 STEWART DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5907
Mailing Address - Country:US
Mailing Address - Phone:630-910-1140
Mailing Address - Fax:
Practice Address - Street 1:812 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1246
Practice Address - Country:US
Practice Address - Phone:630-655-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232677OtherBCBS
IL7476704OtherAETNA
ILK15849Medicare ID - Type Unspecified
IL02232677OtherBCBS