=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790054336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY MICHAEL ENGEL D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2011
-----------------------------------------------------
Last Update Date | 08/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 SW HIGGINS AVE STE 102
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-317-1014
-----------------------------------------------------
Fax | 406-258-0620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 SW HIGGINS AVE STE 102
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59803-1340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-317-1014
-----------------------------------------------------
Fax | 406-317-1014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1277
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------