Provider Demographics
NPI:1891795571
Name:PRISSEL, ANGELA M (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:PRISSEL
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 1:431 E CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3685
Mailing Address - Country:US
Mailing Address - Phone:715-832-2223
Mailing Address - Fax:715-832-7416
Practice Address - Street 1:431 E CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3685
Practice Address - Country:US
Practice Address - Phone:715-832-2223
Practice Address - Fax:715-832-7416
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4036-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI043732396010OtherBLUE CROSS
WI043732396010OtherBLUE CROSS
WI000020018Medicare ID - Type Unspecified