Provider Demographics
NPI:1811080161
Name:GIOLEKAS, ANGELO (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:GIOLEKAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1857
Mailing Address - Country:US
Mailing Address - Phone:508-752-7334
Mailing Address - Fax:508-752-8469
Practice Address - Street 1:488 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1857
Practice Address - Country:US
Practice Address - Phone:508-752-7334
Practice Address - Fax:508-752-8469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2228111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11456131OtherCAQH
MAY36558OtherBLUE CROSS/BLUE SHIELD INDIVIDUAL LEGACY
MAY39517OtherBLUE CROSS/BLUE SHIELD GROUP LEGACY
MA11456131OtherCAQH
MAY36558OtherBLUE CROSS/BLUE SHIELD INDIVIDUAL LEGACY