Healthcare Provider Details

I. General information

NPI: 1710519061
Provider Name (Legal Business Name): AMANDA DRISCOLL DC, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 KANEVILLE RD STE 3
GENEVA IL
60134-2577
US

IV. Provider business mailing address

2401 KANEVILLE RD STE 3
GENEVA IL
60134-2577
US

V. Phone/Fax

Practice location:
  • Phone: 630-715-1183
  • Fax:
Mailing address:
  • Phone: 630-715-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013484
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: