Provider Demographics
NPI:1821094921
Name:ENGEL, ANGELA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:ENGEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N 4TH ST
Mailing Address - Street 2:PO BOX 526
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405
Mailing Address - Country:US
Mailing Address - Phone:715-223-2126
Mailing Address - Fax:715-223-2126
Practice Address - Street 1:109 N 4TH ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-0526
Practice Address - Country:US
Practice Address - Phone:715-223-2126
Practice Address - Fax:715-223-2126
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-09-30
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
WI3872-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI389-42-700Medicaid
WI421615793013OtherBLUE CROSS BLUE SHEILD
WI000035442Medicare ID - Type Unspecified
WI389-42-700Medicaid