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General NPI Number Information
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NPI Number | 1649413410
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Entity Type | Individual
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Provider Name | JOHN NICHOLAS DEANGELIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 1042 WESTMEADE DR
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City | CHESTERFIELD
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State | MO
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Zip | 63005-4609
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Country | US
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Telephone | 330-219-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 WESTMEADE DR
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City | CHESTERFIELD
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State | MO
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Zip | 63005-4609
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Country | US
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Telephone | 330-219-6557
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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 | 2009002883
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011355
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License Number State | IL
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