Provider Demographics
NPI:1982933412
Name:ANGLE, JESSE LEE II (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEE
Last Name:ANGLE
Suffix:II
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 1:12651 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4467
Mailing Address - Country:US
Mailing Address - Phone:239-243-8810
Mailing Address - Fax:239-243-8804
Practice Address - Street 1:12651 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4467
Practice Address - Country:US
Practice Address - Phone:239-243-8810
Practice Address - Fax:239-243-8804
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002345111N00000X
VA0104557279111N00000X
FLCH11021111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor