Provider Demographics
NPI:1386395309
Name:ANGEL, JODY LYNAE (DC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:LYNAE
Last Name:ANGEL
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 1:2030 NORTH LOOP W STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8126
Mailing Address - Country:US
Mailing Address - Phone:346-291-6790
Mailing Address - Fax:
Practice Address - Street 1:2030 NORTH LOOP W STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8126
Practice Address - Country:US
Practice Address - Phone:346-291-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor