Provider Demographics
NPI:1760598080
Name:ENGEN, DEAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:ENGEN
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 1:1557 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4799
Mailing Address - Country:US
Mailing Address - Phone:763-767-7499
Mailing Address - Fax:763-767-7517
Practice Address - Street 1:1557 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4799
Practice Address - Country:US
Practice Address - Phone:763-767-7499
Practice Address - Fax:763-767-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231227100Medicaid
MN350001876Medicare ID - Type Unspecified
MN231227100Medicaid