Provider Demographics
NPI:1417220484
Name:MANNING, JASON RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:MANNING
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 1:2249 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8174
Mailing Address - Country:US
Mailing Address - Phone:616-745-6465
Mailing Address - Fax:
Practice Address - Street 1:4020 DEL MAR DR SW
Practice Address - Street 2:STE 100
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:616-214-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor