Provider Demographics
NPI:1093103764
Name:VANG, CHRISTELLE (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:
Last Name:VANG
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 1:12157 DUNKIRK ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7502
Mailing Address - Country:US
Mailing Address - Phone:763-267-1731
Mailing Address - Fax:
Practice Address - Street 1:12157 DUNKIRK ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-7502
Practice Address - Country:US
Practice Address - Phone:763-267-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor