Provider Demographics
NPI:1134224074
Name:EGLAUF, DOUGLAS R (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:EGLAUF
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 1:12 OLD MAMARONECK RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2010
Mailing Address - Country:US
Mailing Address - Phone:914-686-0010
Mailing Address - Fax:914-686-0206
Practice Address - Street 1:12 OLD MAMARONECK RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2010
Practice Address - Country:US
Practice Address - Phone:914-686-0010
Practice Address - Fax:914-686-0206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX45031Medicare PIN