Provider Demographics
NPI:1619074317
Name:O'BRIEN, ANGELA G (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:G
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:GAMBALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:186 BURRILL ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1835
Mailing Address - Country:US
Mailing Address - Phone:781-593-2388
Mailing Address - Fax:
Practice Address - Street 1:186 BURRILL ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1835
Practice Address - Country:US
Practice Address - Phone:781-593-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY3562501Medicare PIN
MAT58296Medicare UPIN