Provider Demographics
NPI:1194278077
Name:IMGARTEN, ANGELA (DC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:IMGARTEN
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 1:1300 N US HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1975
Mailing Address - Country:US
Mailing Address - Phone:660-542-2441
Mailing Address - Fax:
Practice Address - Street 1:1300 N US HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1975
Practice Address - Country:US
Practice Address - Phone:660-542-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor