Provider Demographics
NPI:1568467926
Name:SANTIAGO, ANGEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:SANTIAGO
Suffix:JR
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 1:550S EDMONDS LN 102
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3577
Mailing Address - Country:US
Mailing Address - Phone:972-956-8297
Mailing Address - Fax:972-956-8257
Practice Address - Street 1:190 CIVIC CIR STE 250
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3648
Practice Address - Country:US
Practice Address - Phone:214-728-8863
Practice Address - Fax:972-956-8257
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1766651-01Medicaid