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General NPI Number Information
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NPI Number | 1053359448
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Entity Type | Individual
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Provider Name | ANGELA J SACKETT D.C.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1278 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5544
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Country | US
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Telephone | 208-528-6010
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Fax | 208-528-6011
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Provider Business Mailing Address
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Address Line | PO BOX 1861
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1861
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Country | US
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Telephone | 208-528-6010
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Fax | 208-528-6011
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-861
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License Number State | ID
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