Provider Demographics
NPI:1760620744
Name:ANGELL CHIROPRACTIC & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:ANGELL CHIROPRACTIC & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-338-5564
Mailing Address - Street 1:1300 QUAIL ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2729
Mailing Address - Country:US
Mailing Address - Phone:949-554-3341
Mailing Address - Fax:949-706-1624
Practice Address - Street 1:1300 QUAIL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2729
Practice Address - Country:US
Practice Address - Phone:949-554-3341
Practice Address - Fax:949-706-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760620744Medicare PIN