Provider Demographics
NPI:1194079020
Name:ENGEL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ENGEL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC DICCP
Authorized Official - Phone:715-223-2126
Mailing Address - Street 1:109 N 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405
Mailing Address - Country:US
Mailing Address - Phone:715-223-2126
Mailing Address - Fax:
Practice Address - Street 1:109 N 4TH STREET
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405
Practice Address - Country:US
Practice Address - Phone:715-223-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3872012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38942700Medicaid
WI38942700Medicaid
WI000035442Medicare PIN