Provider Demographics
NPI:1356329239
Name:MANGIE, RONALD EUGENE JR (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:MANGIE
Suffix:JR
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 1:263 W MCKINLEY WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1688
Mailing Address - Country:US
Mailing Address - Phone:330-707-9127
Mailing Address - Fax:330-707-9129
Practice Address - Street 1:263 W MCKINLEY WAY
Practice Address - Street 2:STE 101
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1688
Practice Address - Country:US
Practice Address - Phone:330-707-9127
Practice Address - Fax:330-707-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2581022Medicaid
OH000000369294OtherANTHEM
OH000000369294OtherANTHEM
OH2581022Medicaid
OHYO9354311Medicare PIN