Provider Demographics
NPI:1013157155
Name:MANGINO BRYAN, MARIANA MANGINO (DC)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:MANGINO
Last Name:MANGINO BRYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:MANGINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:109 NEWTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-207-9840
Mailing Address - Fax:203-207-9849
Practice Address - Street 1:109 NEWTOWN RD.
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-207-9840
Practice Address - Fax:203-207-9849
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001780111N00000X
NYX011550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor