Provider Demographics
NPI:1265833412
Name:DAVENPORT, ANGELA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:DAVENPORT
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 1:340 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2711
Mailing Address - Country:US
Mailing Address - Phone:201-651-9100
Mailing Address - Fax:
Practice Address - Street 1:340 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2711
Practice Address - Country:US
Practice Address - Phone:201-651-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00719900111N00000X
NY012310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor