Provider Demographics
NPI:1790081115
Name:ENGSTROM, JONATHAN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALAN
Last Name:ENGSTROM
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 1:700 N LAKE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1357
Mailing Address - Country:US
Mailing Address - Phone:847-949-0063
Mailing Address - Fax:847-949-2663
Practice Address - Street 1:700 N LAKE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1357
Practice Address - Country:US
Practice Address - Phone:847-949-0063
Practice Address - Fax:847-949-2663
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor