Provider Demographics
NPI:1306972542
Name:MANAGO CHIROPRACTIC INC
Entity type:Organization
Organization Name:MANAGO CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-364-5656
Mailing Address - Street 1:777 CORPORATE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2136
Mailing Address - Country:US
Mailing Address - Phone:949-364-5656
Mailing Address - Fax:949-364-9021
Practice Address - Street 1:777 CORPORATE DR STE 130
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2136
Practice Address - Country:US
Practice Address - Phone:949-364-5656
Practice Address - Fax:949-364-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0146860OtherBLUE CROS BLUE SHIELD
CADC0146860OtherBLUE CROS BLUE SHIELD
CADC14686Medicare ID - Type Unspecified