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General NPI Number Information
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NPI Number | 1548857592
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Entity Type | Individual
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Provider Name | ANGELA VAN WAES DC
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 6312 US 301 N
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City | ELLENTON
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State | FL
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Zip | 34222-3066
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Country | US
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Telephone | 941-304-2054
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 REISSWOOD LOOP
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City | PALMETTO
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State | FL
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Zip | 34221-1316
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Country | US
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Telephone | 386-681-7620
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Fax |
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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 | CH13332
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License Number State | FL
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