Provider Demographics
NPI:1619251964
Name:MANGINO, AARON JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JOSEPH
Last Name:MANGINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 JANKE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3420
Mailing Address - Country:US
Mailing Address - Phone:253-740-7354
Mailing Address - Fax:
Practice Address - Street 1:321 EDWIN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4542
Practice Address - Country:US
Practice Address - Phone:253-740-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor