Provider Demographics
NPI:1992329494
Name:MANGUS, DANIEL ANDREW JR (LAC, CP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ANDREW
Last Name:MANGUS
Suffix:JR
Gender:M
Credentials:LAC, CP
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:ANDREW
Other - Last Name:MANGUS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LAC, CP
Mailing Address - Street 1:112 BEAVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-8841
Mailing Address - Country:US
Mailing Address - Phone:724-875-4649
Mailing Address - Fax:
Practice Address - Street 1:112 BEAVER RUN RD
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-8841
Practice Address - Country:US
Practice Address - Phone:724-875-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty