Provider Demographics
NPI:1629516042
Name:STAUBS, ANGELA JESSIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JESSIE
Last Name:STAUBS
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 1:3947 E CALVARY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1310
Mailing Address - Country:US
Mailing Address - Phone:218-390-5113
Mailing Address - Fax:
Practice Address - Street 1:3947 E CALVARY RD STE 103
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-1310
Practice Address - Country:US
Practice Address - Phone:218-390-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor