Provider Demographics
NPI:1427232693
Name:ANGEL SANTIAGO JR., D.C., P.A.
Entity Type:Organization
Organization Name:ANGEL SANTIAGO JR., D.C., P.A.
Other - Org Name:SANTIAGO FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-956-8297
Mailing Address - Street 1:650 S. EDMONDS LANE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3554
Mailing Address - Country:US
Mailing Address - Phone:972-956-8297
Mailing Address - Fax:972-956-8257
Practice Address - Street 1:650 S EDMONDS LN
Practice Address - Street 2:SUITE 106
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3511
Practice Address - Country:US
Practice Address - Phone:972-956-8297
Practice Address - Fax:972-956-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00411ZMedicare PIN