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General NPI Number Information
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NPI Number | 1306170501
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Entity Type | Organization
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Legal Business Name | JOHN DEANGELIS LLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 1000 LAKE SAINT LOUIS BLVD SUITE 100
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-695-4570
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Fax | 636-625-4554
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Provider Business Mailing Address
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Address Line | 1000 LAKE SAINT BLVD SUITE 100
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-695-4570
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Fax | 636-625-4554
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | JOHN NICHOLAS DEANGELIS
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Credential | D.C.
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Telephone | 330-219-6557
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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 | 2009002883
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License Number State | MO
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