Provider Demographics
NPI:1346600756
Name:MANTONYA CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:MANTONYA CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MANTONYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-366-6601
Mailing Address - Street 1:905 N 21ST STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7251
Mailing Address - Country:US
Mailing Address - Phone:740-366-6601
Mailing Address - Fax:740-366-6286
Practice Address - Street 1:149 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-9669
Practice Address - Country:US
Practice Address - Phone:740-928-7686
Practice Address - Fax:740-928-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty