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General NPI Number Information
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NPI Number | 1770990855
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Entity Type | Individual
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Provider Name | KIP MANGAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 1905 E BIG BEAVER RD
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City | TROY
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State | MI
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Zip | 48083-2006
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Country | US
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Telephone | 248-720-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 29377 MAURICE CT
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City | CHESTERFIELD
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State | MI
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Zip | 48047-3750
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Country | US
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Telephone |
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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 | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 2301010154
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License Number State | MI
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