Provider Demographics
NPI:1972626455
Name:ENGELHOVEN, MAX ED (DC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:ED
Last Name:ENGELHOVEN
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 1:1409 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
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20954Medicare UPIN
591707475Medicare PIN