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Individual

MS. JENNIFER NICOLE MANGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DC

Contact information

Practice address
13955 W PRESERVE BLVD # 200, BURNSVILLE, MN 55337-7733
(952) 890-0804
(952) 890-1095
Mailing address
13955 W PRESERVE BLVD # 200, BURNSVILLE, MN 55337-7733
(952) 890-0804
(952) 890-1095

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4585
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
499T6MA
BCBS PRIVODER NUMBER
MN
Enumeration date
08/03/2006
Last updated
07/08/2007
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