Provider Demographics
NPI:1437306420
Name:PANGELINAN, MICHAEL JOAQUIN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOAQUIN
Last Name:PANGELINAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 SHORT WAY ST # B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4050
Mailing Address - Country:US
Mailing Address - Phone:310-766-6453
Mailing Address - Fax:
Practice Address - Street 1:10628 RIVERSIDE DR
Practice Address - Street 2:STE 1
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2358
Practice Address - Country:US
Practice Address - Phone:310-766-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor