Healthcare Provider Details

I. General information

NPI: 1114577079
Provider Name (Legal Business Name): CAMP CHIROTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 W ALGONQUIN RD
ALGONQUIN ID
60102
US

IV. Provider business mailing address

2927 IMPRESSIONS DR
LAKE IN THE HILLS IL
60156-6700
US

V. Phone/Fax

Practice location:
  • Phone: 224-325-4119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA ELIZABETH GERKE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 414-469-4193