Provider Demographics
NPI:1972664654
Name:MANGANO CHIROPRACTIC AND WELLNESS CENTER, LTD
Entity type:Organization
Organization Name:MANGANO CHIROPRACTIC AND WELLNESS CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-313-2355
Mailing Address - Street 1:6477 COLLEGE PARK SQ
Mailing Address - Street 2:SUITE 216
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:757-313-2355
Mailing Address - Fax:757-313-2357
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:SUITE 216
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-313-2355
Practice Address - Fax:757-313-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA259240OtherANTHEM BCBS
VA259240OtherANTHEM BCBS