Healthcare Provider Details

I. General information

NPI: 1023085958
Provider Name (Legal Business Name): DALE LEE HEMKER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E FAIRCHILD ST
DANVILLE IL
61832-3114
US

IV. Provider business mailing address

1662 N FRANKLIN ST
DANVILLE IL
61832-2364
US

V. Phone/Fax

Practice location:
  • Phone: 217-444-1599
  • Fax: 217-444-1559
Mailing address:
  • Phone: 217-442-2877
  • Fax: 217-444-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: