Healthcare Provider Details

I. General information

NPI: 1871165639
Provider Name (Legal Business Name): BROOKE OLBERDING DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN AVE
MILLEDGEVILLE IL
61051-9506
US

IV. Provider business mailing address

PO BOX 132
MILLEDGEVILLE IL
61051-0132
US

V. Phone/Fax

Practice location:
  • Phone: 815-855-3061
  • Fax:
Mailing address:
  • Phone: 815-855-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: