Provider Demographics
NPI:1073658514
Name:ANGELLO, CHRISTOPHER J (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:ANGELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 PATTERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1941
Mailing Address - Country:US
Mailing Address - Phone:970-248-9833
Mailing Address - Fax:970-248-9835
Practice Address - Street 1:2646 PATTERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1941
Practice Address - Country:US
Practice Address - Phone:970-248-9833
Practice Address - Fax:970-248-9835
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98682Medicare UPIN
CO804557Medicare ID - Type Unspecified