Provider Demographics
NPI:1205928835
Name:MANGES, STANLEY SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SAMUEL
Last Name:MANGES
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 1:145 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1259
Mailing Address - Country:US
Mailing Address - Phone:814-652-9348
Mailing Address - Fax:814-652-0189
Practice Address - Street 1:145 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1259
Practice Address - Country:US
Practice Address - Phone:814-652-9348
Practice Address - Fax:814-652-0189
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001409L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006298070002Medicaid
PA0006298070002Medicaid
T29072Medicare UPIN