Provider Demographics
NPI:1053457580
Name:MUSTAC, ANGELA (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MUSTAC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S MAIN ST
Mailing Address - Street 2:2B
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4219
Mailing Address - Country:US
Mailing Address - Phone:203-294-1200
Mailing Address - Fax:203-294-9077
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:2B
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4219
Practice Address - Country:US
Practice Address - Phone:203-294-1200
Practice Address - Fax:203-294-9077
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001627111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation