MEDICARE: DR. ANTHONY PAUL DEANGELO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3280	SC

General Provider Information

NPI Number	:	1386844793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY PAUL DEANGELO D.C.

Provider Business Mailing Address
First Line	:	400 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6029
Country	:	US
Telephone Number	:	843-238-5900
Fax Number	:	843-238-5910

Provider Business Practice Location Address
First Line	:	400 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6029
Country	:	US
Telephone Number	:	843-238-5900
Fax Number	:	843-238-5910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/10/2008

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