Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-006108 | IL |
N | 111N00000X | Chiropractor | A05384 | IA |
N | 111NR0200X | Radiology | 9214347 | IL |
N | 213ER0200X | Radiology | 9214347 | IL |
NPI | 1639256118 |
---|---|
Provider Name | Dr. Harlene Rosemary Mangan |
First Address | Moline, IL 61265-3637 |
Second Address | Moline, IL 61265-3637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 05/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038006108 | (05) | IL |
08182055 | BLUE CROSS BLUE SHIELD (01) | IL |
T87547 | (02) | IL |