Provider Demographics
NPI:1649392473
Name:ANGEL, TED O (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:O
Last Name:ANGEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04605-6218
Mailing Address - Country:US
Mailing Address - Phone:207-854-2626
Mailing Address - Fax:
Practice Address - Street 1:747 OAK POINT RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605-6218
Practice Address - Country:US
Practice Address - Phone:207-854-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31313Medicare UPIN