Provider Demographics
NPI:1821162298
Name:ENGELKE, LEROY DARWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:DARWIN
Last Name:ENGELKE
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 1:15 ROSEWOOD
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1508
Mailing Address - Country:US
Mailing Address - Phone:949-830-6295
Mailing Address - Fax:949-756-0764
Practice Address - Street 1:18102 SKY PARK CIR STE D
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6531
Practice Address - Country:US
Practice Address - Phone:949-756-0764
Practice Address - Fax:949-756-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor