MEDICARE: DR. CLARISSA L ENGEN DC

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	111NR0400X	Rehabilitation Chiropractor	CH60913088	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH60913088	OTHER	WA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1629639711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA L ENGEN DC

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	210-318-3007
Fax Number	:	210-468-0682

Provider Business Practice Location Address
First Line	:	3204 SMOKEY POINT DR STE 102
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8476
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	800-404-6050

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	04/03/2025

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Directions to “ DR. CLARISSA L ENGEN DC” Practice Location

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