Provider Demographics
NPI:1619355278
Name:SAMUELSON, ANGELA (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1015 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2407
Mailing Address - Country:US
Mailing Address - Phone:913-449-2295
Mailing Address - Fax:
Practice Address - Street 1:10850 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1613
Practice Address - Country:US
Practice Address - Phone:913-234-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor