Provider Demographics
NPI:1508961186
Name:MANGEN, JEROME FRANCIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:FRANCIS
Last Name:MANGEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2508 EDGEMONT DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-3844
Mailing Address - Country:US
Mailing Address - Phone:620-442-7120
Mailing Address - Fax:620-442-7121
Practice Address - Street 1:2508 EDGEMONT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-3844
Practice Address - Country:US
Practice Address - Phone:620-442-7120
Practice Address - Fax:620-442-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007325Medicare ID - Type Unspecified