Provider Demographics
NPI:1750460796
Name:ENGEL, CREIGHTON V (DC)
Entity Type:Individual
Prefix:DR
First Name:CREIGHTON
Middle Name:V
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 1:108 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-3001
Mailing Address - Country:US
Mailing Address - Phone:618-548-5255
Mailing Address - Fax:618-548-4625
Practice Address - Street 1:108 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-3001
Practice Address - Country:US
Practice Address - Phone:618-548-5255
Practice Address - Fax:618-548-4625
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-003670OtherLICENSE NUMBER
IL6182006OtherBLUE CROSS/BLUE SHIELD
IL37-1392751OtherTAX IDENTIFICATION
IL6182006OtherBLUE CROSS/BLUE SHIELD
IL570090Medicare ID - Type Unspecified