Individual
DR. JERRY ALLEN MANTONYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
919 N 21ST ST, NEWARK, OH 43055-2919
(740) 366-6601
(740) 366-6286
Mailing address
919 N 21ST ST, NEWARK, OH 43055-2919
(740) 366-6601
(740) 366-6286
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
451
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000117115
ANTHEM BC/BS
OH
05
—
0186883
—
OH
01
—
310811048029
CARESOURCE
OH
Enumeration date
07/14/2005
Last updated
04/20/2008
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