Provider Demographics
NPI:1487630620
Name:WATHAN, ANGELA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LOUISE
Last Name:WATHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:LOUISE
Other - Last Name:DUFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2593 US HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9507
Mailing Address - Country:US
Mailing Address - Phone:406-890-2212
Mailing Address - Fax:406-890-2234
Practice Address - Street 1:2593 US HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-9507
Practice Address - Country:US
Practice Address - Phone:406-890-2212
Practice Address - Fax:406-890-2234
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1449678Medicaid
IAV04215Medicare UPIN
IA1449678Medicaid
IAI15381Medicare PIN
IA1449678Medicaid