Provider Demographics
NPI:1720749781
Name:ENGELSTAD, MACKENZIE (DC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:ENGELSTAD
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 1:2330 CROSSTOWN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4471
Mailing Address - Country:US
Mailing Address - Phone:507-382-9026
Mailing Address - Fax:
Practice Address - Street 1:2330 CROSSTOWN BLVD NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-4471
Practice Address - Country:US
Practice Address - Phone:507-382-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
6946OtherSTATE ISSUED