Provider Demographics
NPI:1649413410
Name:DEANGELIS, JOHN NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:DEANGELIS
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 1:1042 WESTMEADE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4609
Mailing Address - Country:US
Mailing Address - Phone:330-219-6557
Mailing Address - Fax:
Practice Address - Street 1:1042 WESTMEADE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-4609
Practice Address - Country:US
Practice Address - Phone:330-219-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009002883111N00000X
IL038.011355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor