Provider Demographics
NPI:1629060611
Name:ENGLER, KEITH JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOSEPH
Last Name:ENGLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:JOSEPH
Other - Last Name:ENGLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:225 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5239
Mailing Address - Country:US
Mailing Address - Phone:386-424-9977
Mailing Address - Fax:386-423-3899
Practice Address - Street 1:225 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-424-9977
Practice Address - Fax:386-423-3899
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006443111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380098900Medicaid
FL380098900Medicaid
FLFP935AMedicare PIN