Provider Demographics
NPI:1629089388
Name:ENGEL, RICHARD A (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
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 1:4295 GESNER ST.
Mailing Address - Street 2:1D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6646
Mailing Address - Country:US
Mailing Address - Phone:619-275-3680
Mailing Address - Fax:619-275-6745
Practice Address - Street 1:4295 GESNER ST.
Practice Address - Street 2:1D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6646
Practice Address - Country:US
Practice Address - Phone:619-275-3680
Practice Address - Fax:619-275-6745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330266030OtherEMPLOYER IDENTIFICATION N
CA330266030OtherEMPLOYER IDENTIFICATION N