Healthcare Provider Details

I. General information

NPI: 1487943445
Provider Name (Legal Business Name): MANGI CHIROPRACTIC & ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E SAINT LOUIS AVE
EAST ALTON IL
62024-1542
US

IV. Provider business mailing address

133 E SAINT LOUIS AVE
EAST ALTON IL
62024-1542
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-8000
  • Fax:
Mailing address:
  • Phone: 618-259-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011593
License Number StateIL

VIII. Authorized Official

Name: DR. ANDREA M. MANGI
Title or Position: OWNER
Credential: D.C.
Phone: 618-304-8447