Provider Demographics
NPI:1972387470
Name:PAGE, ANNALEE NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:ANNALEE
Middle Name:NICOLE
Last Name:PAGE
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 1:324 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2670
Mailing Address - Country:US
Mailing Address - Phone:209-505-4385
Mailing Address - Fax:
Practice Address - Street 1:826 W EDISON RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-2744
Practice Address - Country:US
Practice Address - Phone:574-256-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003399A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor