Provider Demographics
NPI:1588856108
Name:GIVERTS, ANGELICA
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:GIVERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:GIVERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3921 POND VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2450
Mailing Address - Country:US
Mailing Address - Phone:215-671-0900
Mailing Address - Fax:
Practice Address - Street 1:111 BUCK RD, OFFICE 100, SUITE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1900
Practice Address - Country:US
Practice Address - Phone:215-330-4242
Practice Address - Fax:215-330-4242
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 0063L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030715640001Medicaid