Provider Demographics
NPI:1063588499
Name:ROBERTS, ANGELLA L (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELLA
Middle Name:L
Last Name:ROBERTS
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 1:43 EXCHANGE ST
Mailing Address - Street 2:P.O. BOX 735
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2037
Mailing Address - Country:US
Mailing Address - Phone:207-369-9138
Mailing Address - Fax:207-369-9273
Practice Address - Street 1:43 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2037
Practice Address - Country:US
Practice Address - Phone:207-369-9138
Practice Address - Fax:207-369-9273
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060952OtherBLUE CROSS BLUE SHIELD
MEME0232Medicare ID - Type Unspecified
ME060952OtherBLUE CROSS BLUE SHIELD