Healthcare Provider Details

I. General information

NPI: 1114053840
Provider Name (Legal Business Name): ANDRENA SAYLES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 N MAIN ST
PECATONICA IL
61063
US

IV. Provider business mailing address

650 MERRION RD
ROSCOE IL
61073-6302
US

V. Phone/Fax

Practice location:
  • Phone: 815-239-1121
  • Fax: 815-239-2766
Mailing address:
  • Phone: 815-623-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009552
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: