Individual
THEODIS MANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8320 NE 10TH ST, MIDWEST CITY, OK 73110-7155
(405) 761-3041
Mailing address
8320 NE 10TH ST, MIDWEST CITY, OK 73110-7155
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392068921
PRIVATE AGENCY
OK
Enumeration date
07/25/2012
Last updated
07/25/2012
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