MEDICARE: EDWARD ALLEN HENGEL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	005518	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7788	OTHER	MO	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1669566410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ALLEN HENGEL D.C.

Provider Business Mailing Address
First Line	:	4006 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1314
Country	:	US
Telephone Number	:	314-631-5550
Fax Number	:	314-631-5557

Provider Business Practice Location Address
First Line	:	4006 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1314
Country	:	US
Telephone Number	:	314-631-5550
Fax Number	:	314-631-5557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/13/2008

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