Provider Demographics
NPI:1326572199
Name:MANGINELLI, MIKE
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:MANGINELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W SOMERSET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2026
Mailing Address - Country:US
Mailing Address - Phone:973-534-8089
Mailing Address - Fax:908-725-2453
Practice Address - Street 1:55 W SOMERSET ST STE 2
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2026
Practice Address - Country:US
Practice Address - Phone:973-534-8089
Practice Address - Fax:908-725-2453
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor