Provider Demographics
NPI:1053743971
Name:HOUSTON, ANGELICA (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:HOUSTON
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 1:510 DAVIS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9664
Mailing Address - Country:US
Mailing Address - Phone:516-220-2821
Mailing Address - Fax:
Practice Address - Street 1:510 DAVIS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9664
Practice Address - Country:US
Practice Address - Phone:516-220-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor