Provider Demographics
NPI:1144695255
Name:WALKER-GILLIS, ANGELA RENEE (DC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:WALKER-GILLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:WALKER-GILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:200 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5525
Mailing Address - Country:US
Mailing Address - Phone:954-658-6414
Mailing Address - Fax:954-449-6414
Practice Address - Street 1:200 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-658-6414
Practice Address - Fax:954-449-6414
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11840111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANONEOtherNONE