Provider Demographics
NPI:1801443536
Name:CANGELOSI, CARLY B (DC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:B
Last Name:CANGELOSI
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-0307
Mailing Address - Country:US
Mailing Address - Phone:706-846-2787
Mailing Address - Fax:706-846-2747
Practice Address - Street 1:6298 VETERANS PKWY STE 10E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6253
Practice Address - Country:US
Practice Address - Phone:706-327-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor