Provider Demographics
NPI:1982934246
Name:MANGI, ANDREA M
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:M
Last Name:MANGI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:MANGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:133 E SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1542
Mailing Address - Country:US
Mailing Address - Phone:618-259-8000
Mailing Address - Fax:
Practice Address - Street 1:133 E SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-1542
Practice Address - Country:US
Practice Address - Phone:618-259-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor