Provider Demographics
NPI:1154505030
Name:MANGAS CHIROPRACTIC
Entity Type:Organization
Organization Name:MANGAS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-247-1717
Mailing Address - Street 1:6699 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3926
Mailing Address - Country:US
Mailing Address - Phone:317-247-1717
Mailing Address - Fax:317-247-7704
Practice Address - Street 1:6699 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3926
Practice Address - Country:US
Practice Address - Phone:317-247-1717
Practice Address - Fax:317-247-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT35032Medicare UPIN
IN797210Medicare PIN