Provider Demographics
NPI:1588943690
Name:MANOR, LAKEIA MONIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:LAKEIA
Middle Name:MONIQUE
Last Name:MANOR
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:PO BOX 24102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403-4102
Mailing Address - Country:US
Mailing Address - Phone:912-695-5001
Mailing Address - Fax:844-695-5001
Practice Address - Street 1:3025 BULL ST
Practice Address - Street 2:216
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2016
Practice Address - Country:US
Practice Address - Phone:912-695-5001
Practice Address - Fax:844-695-5001
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I358491OtherMEDICARE PTAN