Provider Demographics
NPI:1700825031
Name:ENGLE, W. WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:WALTER
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 1:83 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9312
Mailing Address - Country:US
Mailing Address - Phone:717-336-1224
Mailing Address - Fax:717-336-1225
Practice Address - Street 1:83 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-9312
Practice Address - Country:US
Practice Address - Phone:717-336-1224
Practice Address - Fax:717-336-1225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002375-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0905427Medicaid
PAT72762Medicare UPIN
PA0905427Medicaid