Provider Demographics
NPI:1083730295
Name:ENGELMANN, ERIC LEE (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:ENGELMANN
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 1:120 SE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5519
Mailing Address - Country:US
Mailing Address - Phone:305-885-4533
Mailing Address - Fax:305-885-0539
Practice Address - Street 1:120 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5519
Practice Address - Country:US
Practice Address - Phone:305-885-4533
Practice Address - Fax:305-885-0539
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050432700Medicaid
FL22750Medicare ID - Type Unspecified
FL050432700Medicaid