Provider Demographics
NPI:1942482401
Name:ANGELOTTI, JANINE (DC,QME)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:ANGELOTTI
Suffix:
Gender:F
Credentials:DC,QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W KELLY RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3885
Mailing Address - Country:US
Mailing Address - Phone:818-606-9354
Mailing Address - Fax:805-262-2790
Practice Address - Street 1:275 W KELLY RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3885
Practice Address - Country:US
Practice Address - Phone:818-606-9354
Practice Address - Fax:805-262-2790
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22274Medicare PIN