Provider Demographics
NPI:1386765816
Name:ANGLEN, ROBERT LINDSAY (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LINDSAY
Last Name:ANGLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11214 W SUNFLOWER PL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-3626
Mailing Address - Country:US
Mailing Address - Phone:623-877-1982
Mailing Address - Fax:623-877-1982
Practice Address - Street 1:11214 W SUNFLOWER PL
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-3626
Practice Address - Country:US
Practice Address - Phone:623-877-1982
Practice Address - Fax:623-877-1982
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0234550OtherBLUE CROSS BLUE SHIELD
AZZ26505Medicare ID - Type UnspecifiedMEDICARE