Provider Demographics
NPI:1396889689
Name:MANGUM, DONALD LANCE (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LANCE
Last Name:MANGUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2112 N HILL FIELD RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4047
Mailing Address - Country:US
Mailing Address - Phone:801-774-0555
Mailing Address - Fax:801-774-0588
Practice Address - Street 1:2112 N HILL FIELD RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4047
Practice Address - Country:US
Practice Address - Phone:801-774-0555
Practice Address - Fax:801-774-0588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT175753-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor