Provider Demographics
NPI:1932123346
Name:VAN ENGEN, MERVIN ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:MERVIN
Middle Name:ROY
Last Name:VAN ENGEN
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 1:7435 O ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2444
Mailing Address - Country:US
Mailing Address - Phone:402-486-3858
Mailing Address - Fax:402-486-3859
Practice Address - Street 1:7435 O ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2444
Practice Address - Country:US
Practice Address - Phone:402-486-3858
Practice Address - Fax:402-486-3859
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor