Provider Demographics
NPI:1922025352
Name:VITALE, ANGELA TRUDY (DC LLC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:TRUDY
Last Name:VITALE
Suffix:
Gender:F
Credentials:DC LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2260
Mailing Address - Country:US
Mailing Address - Phone:970-669-7944
Mailing Address - Fax:
Practice Address - Street 1:344 W 37TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2260
Practice Address - Country:US
Practice Address - Phone:970-669-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009180111N00000X
CO6795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-F3-3365-0Medicare UPIN