Provider Demographics
NPI:1356844310
Name:MANGINO, SHAWNEE ROSE (DC)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:ROSE
Last Name:MANGINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W WACKERLY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2795
Mailing Address - Country:US
Mailing Address - Phone:989-837-5998
Mailing Address - Fax:989-835-9632
Practice Address - Street 1:214 W WACKERLY ST STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2795
Practice Address - Country:US
Practice Address - Phone:989-837-5998
Practice Address - Fax:989-835-9632
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor