Provider Demographics
NPI:1598019630
Name:CANTRELL, ANGELA L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 CROW CANYON RD STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:925-848-3900
Practice Address - Street 1:2819 CROW CANYON RD STE 213
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1657
Practice Address - Country:US
Practice Address - Phone:650-714-0347
Practice Address - Fax:925-848-3900
Is Sole Proprietor?:No
Enumeration Date:2012-10-27
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor