Provider Demographics
NPI:1588772677
Name:ENGELHOVEN CHIROPRACTIC PA
Entity type:Organization
Organization Name:ENGELHOVEN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:ED
Authorized Official - Last Name:ENGELHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-835-7902
Mailing Address - Street 1:1409 E KIEHL AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3041
Mailing Address - Country:US
Mailing Address - Phone:501-835-7902
Mailing Address - Fax:501-835-7908
Practice Address - Street 1:1409 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3041
Practice Address - Country:US
Practice Address - Phone:501-835-7902
Practice Address - Fax:501-835-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T20594Medicare UPIN
591707475Medicare PIN