Provider Demographics
NPI:1760534374
Name:PATE, ANGELA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RENEE
Last Name:PATE
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 1:5457 COUNTY ROAD 4116
Mailing Address - Street 2:
Mailing Address - City:SIMMS
Mailing Address - State:TX
Mailing Address - Zip Code:75574-5478
Mailing Address - Country:US
Mailing Address - Phone:214-789-6420
Mailing Address - Fax:
Practice Address - Street 1:5457 COUNTY ROAD 4116
Practice Address - Street 2:
Practice Address - City:SIMMS
Practice Address - State:TX
Practice Address - Zip Code:75574-5478
Practice Address - Country:US
Practice Address - Phone:903-748-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609251Medicare ID - Type Unspecified