Provider Demographics
NPI:1982646345
Name:BREMER, ANGELA JO (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:BREMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JO
Other - Last Name:YEARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10393 S GULL LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:TENSTRIKE
Mailing Address - State:MN
Mailing Address - Zip Code:56683-2015
Mailing Address - Country:US
Mailing Address - Phone:218-586-3457
Mailing Address - Fax:
Practice Address - Street 1:223 3RD ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3111
Practice Address - Country:US
Practice Address - Phone:218-333-8811
Practice Address - Fax:218-333-8813
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN009H3BRMedicare UPIN