Provider Demographics
NPI:1982602090
Name:VAN ENGEN, SUMMER (DC)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:
Last Name:VAN ENGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUMMER
Other - Middle Name:KAYE
Other - Last Name:VAN SCHOUWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3113 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-800-5940
Mailing Address - Fax:512-800-5940
Practice Address - Street 1:3113 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7422
Practice Address - Country:US
Practice Address - Phone:512-710-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15060Medicare ID - Type Unspecified
IAV04824Medicare UPIN