Provider Demographics
NPI:1053620435
Name:MANNING, HEIDI MARIAN (LAC, LMT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIAN
Last Name:MANNING
Suffix:
Gender:F
Credentials:LAC, LMT
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 453
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-0453
Mailing Address - Country:US
Mailing Address - Phone:541-992-5175
Mailing Address - Fax:866-456-0314
Practice Address - Street 1:35170 BROOTEN RD
Practice Address - Street 2:
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135-8036
Practice Address - Country:US
Practice Address - Phone:541-992-5175
Practice Address - Fax:503-483-1116
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR157589171100000X
WAAC00002709171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist