Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 001627 | CT |
NPI | 1053457580 |
---|---|
Provider Name | Angela Mustac |
First Address | Wallingford, CT 06492-4219 |
Second Address | Wallingford, CT 06492-4219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 13/09/2007 |