Provider Demographics
NPI:1083752323
Name:ENGSTROM, CYNTHIA GRILK (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:GRILK
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:E
Other - Last Name:GRILK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:738 WALNUT STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78939-2304
Mailing Address - Country:US
Mailing Address - Phone:979-732-6186
Mailing Address - Fax:
Practice Address - Street 1:738 WALNUT STREET
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78939-2304
Practice Address - Country:US
Practice Address - Phone:979-732-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX602037OtherBLUE CROSS BLUE SHIELD
602037Medicare ID - Type Unspecified