Provider Demographics
NPI:1871594721
Name:ANGOVE, DOUGLAS HUNTLEY (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HUNTLEY
Last Name:ANGOVE
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 1:1608 HILLSBORO AVE NO
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427
Mailing Address - Country:US
Mailing Address - Phone:763-545-3317
Mailing Address - Fax:763-545-3317
Practice Address - Street 1:1608 HILLSBORO AVE NO
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:763-545-3317
Practice Address - Fax:763-545-3317
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN817527600Medicaid
MNOD422ANOtherBCBS PRACTICE ID
MN59333ANOtherBCBS OF MN ID
MN1703OtherSTATE LICENSE #
MN1703OtherSTATE LICENSE #