Healthcare Provider Details

I. General information

NPI: 1649392473
Provider Name (Legal Business Name): TED O. ANGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 OAK POINT RD
TRENTON ME
04605-6218
US

IV. Provider business mailing address

747 OAK POINT RD
TRENTON ME
04605-6218
US

V. Phone/Fax

Practice location:
  • Phone: 207-854-2626
  • Fax:
Mailing address:
  • Phone: 207-854-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR629
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: