Provider Demographics
NPI:1255515177
Name:MANGANELLI, ANTHONY SILIVIO (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SILIVIO
Last Name:MANGANELLI
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 1:7 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2829
Mailing Address - Country:US
Mailing Address - Phone:410-544-7074
Mailing Address - Fax:410-544-3983
Practice Address - Street 1:7 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2829
Practice Address - Country:US
Practice Address - Phone:410-544-7074
Practice Address - Fax:410-544-3983
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW3780001OtherBCBS FEDERAL
MDE492 1347OtherBCBS
T59467Medicare UPIN
MD857L152EMedicare PIN