Provider Demographics
NPI:1629314687
Name:ERICH E. MENGE, DC,PA
Entity Type:Organization
Organization Name:ERICH E. MENGE, DC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-495-4357
Mailing Address - Street 1:4801 LINTON BLVD STE 9A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6501
Mailing Address - Country:US
Mailing Address - Phone:561-495-4357
Mailing Address - Fax:
Practice Address - Street 1:4801 LINTON BLVD STE 9A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6501
Practice Address - Country:US
Practice Address - Phone:561-495-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7209250OtherAETNA
88701OtherBLUE CROSS BLUE SHIELD
2138246OtherUNITED
1414695OtherCIGNA
2138246OtherUNITED