Provider Demographics
NPI:1033383484
Name:MICHAUD, ANGELA MARIE (BS, DC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:BS, DC, CSCS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:PFEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, DC, CSCS
Mailing Address - Street 1:4320 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5925
Mailing Address - Country:US
Mailing Address - Phone:907-729-4326
Mailing Address - Fax:907-729-4102
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-4326
Practice Address - Fax:907-729-4102
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007059111N00000X
AK481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0078Medicaid