Provider Demographics
NPI:1841477627
Name:ELLIOT, ANGELA (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ELLIOT
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 1:2485 MAPLEWOOD DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-9401
Mailing Address - Country:US
Mailing Address - Phone:651-484-9009
Mailing Address - Fax:651-765-0995
Practice Address - Street 1:2485 MAPLEWOOD DR
Practice Address - Street 2:SUITE 215
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1978
Practice Address - Country:US
Practice Address - Phone:651-484-9009
Practice Address - Fax:651-765-0995
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4376-12111N00000X
MN5192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor