Provider Demographics
NPI:1982780011
Name:ANGELY, TIMOTHY WRIGHT (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WRIGHT
Last Name:ANGELY
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 1:1953 E 70TH ST
Mailing Address - Street 2:SUITE ONE
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:318-797-1502
Practice Address - Street 1:1953 E 70TH ST
Practice Address - Street 2:SUITE ONE
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:318-797-1502
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU57635Medicare UPIN
4C548CT61Medicare ID - Type Unspecified