Provider Demographics
NPI:1811181340
Name:TIMOTHY W. ANGELY, D.C., INC.
Entity type:Organization
Organization Name:TIMOTHY W. ANGELY, D.C., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-797-1505
Mailing Address - Street 1:1953 E 70TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5300
Mailing Address - Country:US
Mailing Address - Phone:318-797-1505
Mailing Address - Fax:
Practice Address - Street 1:1953 E 70TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5300
Practice Address - Country:US
Practice Address - Phone:318-797-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU57635Medicare UPIN
LA4C548CT61Medicare PIN