Provider Demographics
NPI:1164554663
Name:ENGEL, JOHN CARLTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARLTON
Last Name:ENGEL
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 1:161 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2233
Mailing Address - Country:US
Mailing Address - Phone:978-468-7976
Mailing Address - Fax:
Practice Address - Street 1:161 BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2233
Practice Address - Country:US
Practice Address - Phone:978-468-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7531376OtherCIGNA
MA799211OtherTUFTS #
MA0012604060001OtherUNITED HEALTH
MA350313OtherHARVARD HEALTH
MA2303849OtherAETNA
MA615968OtherACN
MAY36289OtherBLUE CROSS BLUE SHIELD #
MAY36289OtherBLUE CROSS BLUE SHIELD #
MAJOY49026Medicare ID - Type UnspecifiedMEDICARE #