Provider Demographics
NPI:1053595777
Name:THIELE, ANGELA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RENEE
Last Name:THIELE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 PROGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2475
Mailing Address - Country:US
Mailing Address - Phone:715-623-5481
Mailing Address - Fax:715-627-0177
Practice Address - Street 1:2006 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2475
Practice Address - Country:US
Practice Address - Phone:715-623-5481
Practice Address - Fax:715-627-0177
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4371-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor