Provider Demographics
NPI:1871642181
Name:HIMANGA, SHIRLEY N (DC)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:N
Last Name:HIMANGA
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 1:7447 EGAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3303
Mailing Address - Country:US
Mailing Address - Phone:952-447-3343
Mailing Address - Fax:952-226-5504
Practice Address - Street 1:7447 EGAN DR STE 201
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-3303
Practice Address - Country:US
Practice Address - Phone:952-447-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4497111N00000X
VA0104556253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305M4QUOtherBCBS CONTRACTING PROVIDER
MN305M5HIOtherBCBS INDIVIDUAL NUMBER
MNV00269Medicare UPIN