Provider Demographics
NPI:1316035710
Name:ENGLE, MARK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:ENGLE
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 1:4751 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:330-847-1707
Mailing Address - Fax:330-847-1709
Practice Address - Street 1:4751 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-847-1707
Practice Address - Fax:330-847-1709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHEN0832522Medicare ID - Type Unspecified