Provider Demographics
NPI:1962578013
Name:MACANGA, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MACANGA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W BAGLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1943
Mailing Address - Country:US
Mailing Address - Phone:440-826-1440
Mailing Address - Fax:440-826-1126
Practice Address - Street 1:165 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1856
Practice Address - Country:US
Practice Address - Phone:440-826-1440
Practice Address - Fax:440-826-1126
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV02252Medicare UPIN
OHV02252Medicare UPIN