Provider Demographics
NPI:1598869117
Name:UPCHURCH, ANGELA RENAE (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENAE
Last Name:UPCHURCH
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 1:11300 REGENCY GREEN DR APT 1002
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3049
Mailing Address - Country:US
Mailing Address - Phone:281-970-3234
Mailing Address - Fax:
Practice Address - Street 1:25440 INTERSTATE 45
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1343
Practice Address - Country:US
Practice Address - Phone:281-367-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX383927ZLKTMedicare PIN