Provider Demographics
NPI:1245419282
Name:ANGELL CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ANGELL CHIROPRACTIC, P.C.
Other - Org Name:LE CENTER CHIROPRACTIC & SPORTS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-357-4404
Mailing Address - Street 1:36 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057-1511
Mailing Address - Country:US
Mailing Address - Phone:507-357-4404
Mailing Address - Fax:507-357-6494
Practice Address - Street 1:36 N PARK AVE
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1511
Practice Address - Country:US
Practice Address - Phone:507-357-4404
Practice Address - Fax:507-357-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03220OtherMEDICARE GROUP ID#
MN902271600Medicaid
MN350002759Medicare PIN
MN902271600Medicaid