Provider Demographics
NPI:1174531826
Name:MANN, JOHN HEROD III (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HEROD
Last Name:MANN
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2515 E GLENN AVE
Mailing Address - Street 2:STE. 104
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6453
Mailing Address - Country:US
Mailing Address - Phone:334-821-2256
Mailing Address - Fax:334-826-8082
Practice Address - Street 1:2515 E GLENN AVE
Practice Address - Street 2:STE. 104
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6453
Practice Address - Country:US
Practice Address - Phone:334-821-2256
Practice Address - Fax:334-826-8082
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516578OtherBLUECROSSBLUESHIELD OF AL
ALT68499Medicare UPIN