Provider Demographics
NPI:1386660421
Name:DIMARTINO, ANGELA MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIA
Last Name:DIMARTINO
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 1:30120 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2190
Mailing Address - Country:US
Mailing Address - Phone:586-949-9248
Mailing Address - Fax:586-949-6048
Practice Address - Street 1:30120 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2190
Practice Address - Country:US
Practice Address - Phone:586-949-9248
Practice Address - Fax:586-949-6048
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4590513Medicaid
MIU95070Medicare UPIN
MI4590513Medicaid