Provider Demographics
NPI:1831895648
Name:CALVIN E. MANG, DCPC
Entity type:Organization
Organization Name:CALVIN E. MANG, DCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-267-6777
Mailing Address - Street 1:790 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4627
Mailing Address - Country:US
Mailing Address - Phone:541-756-0525
Mailing Address - Fax:541-808-0990
Practice Address - Street 1:790 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4627
Practice Address - Country:US
Practice Address - Phone:541-756-0525
Practice Address - Fax:541-808-0990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVIN E. MANG, DC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1780715953Medicaid