Provider Demographics
NPI:1366611097
Name:SANTANGELO, ANTHONY VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:SANTANGELO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3258
Mailing Address - Country:US
Mailing Address - Phone:910-875-2500
Mailing Address - Fax:
Practice Address - Street 1:751 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3258
Practice Address - Country:US
Practice Address - Phone:910-875-2500
Practice Address - Fax:910-904-1300
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0828ROtherBC/BS
FH7000190OtherFIRST CAROLINA
NC1841255635OtherNPI ORGANIZATION TYPE
NC2451534AOtherMEDICARE
NC890828RMedicaid
FH7000190OtherFIRST CAROLINA