Provider Demographics
NPI:1780715953
Name:MANG, CALVIN EDWIN (DC)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:EDWIN
Last Name:MANG
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 1:790 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4627
Mailing Address - Country:US
Mailing Address - Phone:541-756-0525
Mailing Address - Fax:541-808-0990
Practice Address - Street 1:790 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-756-0525
Practice Address - Fax:541-808-0990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor