Healthcare Provider Details

I. General information

NPI: 1801973128
Provider Name (Legal Business Name): CYNTHIA DAWN TREHARNE D.C., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 4TH ST
FULTON IL
61252-1718
US

IV. Provider business mailing address

1106 4TH ST
FULTON IL
61252-1718
US

V. Phone/Fax

Practice location:
  • Phone: 815-589-5255
  • Fax: 309-786-7980
Mailing address:
  • Phone: 815-589-5255
  • Fax: 309-786-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010663
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085001604
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001363
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: