Provider Demographics
NPI:1750634366
Name:DEANGELO CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DEANGELO CHIROPRACTIC INC
Other - Org Name:DEANGELO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-204-3924
Mailing Address - Street 1:5182 HORRY DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5240
Mailing Address - Country:US
Mailing Address - Phone:843-651-8787
Mailing Address - Fax:843-651-8788
Practice Address - Street 1:5182 HORRY DR
Practice Address - Street 2:UNIT A
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5240
Practice Address - Country:US
Practice Address - Phone:843-651-8787
Practice Address - Fax:843-651-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty