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General NPI Number Information
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NPI Number | 1386363455
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Entity Type | Individual
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Provider Name | MARIAH JANE MANSPERGER DC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 451 DUNHAM RD
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City | ST CHARLES
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State | IL
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Zip | 60174-1431
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Country | US
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Telephone | 630-549-6474
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N RIVER RD
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City | FOX RIVER GROVE
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State | IL
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Zip | 60021-1021
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Country | US
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Telephone | 419-651-5363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013897
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License Number State | IL
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