Provider Demographics
NPI:1548360688
Name:ENGLERT, GARY P (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:ENGLERT
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:P.O. BOX 45
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:52738
Mailing Address - Country:US
Mailing Address - Phone:319-728-2359
Mailing Address - Fax:319-728-2995
Practice Address - Street 1:205 E. ACCESS RD.
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738
Practice Address - Country:US
Practice Address - Phone:319-728-2359
Practice Address - Fax:319-728-2995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA53328Medicare ID - Type Unspecified