Provider Demographics
NPI:1639256118
Name:MANGAN, HARLENE ROSEMARY (BS,DC,FIAMA)
Entity Type:Individual
Prefix:DR
First Name:HARLENE
Middle Name:ROSEMARY
Last Name:MANGAN
Suffix:
Gender:F
Credentials:BS,DC,FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 48TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3637
Mailing Address - Country:US
Mailing Address - Phone:309-797-4000
Mailing Address - Fax:309-797-5041
Practice Address - Street 1:1510 48TH STREET PL
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3637
Practice Address - Country:US
Practice Address - Phone:309-797-4000
Practice Address - Fax:309-797-5041
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05384111N00000X
IL038-006108111N00000X
IL9214347111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006108Medicaid
IL08182055OtherBLUE CROSS BLUE SHIELD
IL204075Medicare ID - Type Unspecified
IL038006108Medicaid