Provider Demographics
NPI:1780604504
Name:STAFFORD, ANGELA ROSE (MS DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ROSE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BIRCH STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-474-2225
Mailing Address - Fax:949-474-2229
Practice Address - Street 1:3900 BIRCH STREET
Practice Address - Street 2:STE 101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-474-2225
Practice Address - Fax:949-474-2229
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
630441Medicare UPIN
ASDC17602Medicare ID - Type Unspecified