Healthcare Provider Details

I. General information

NPI: 1427209535
Provider Name (Legal Business Name): DRAKE HEALTHCARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7264 ARGUS DR
ROCKFORD IL
61107-5837
US

IV. Provider business mailing address

7264 ARGUS DR
ROCKFORD IL
61107-5837
US

V. Phone/Fax

Practice location:
  • Phone: 815-229-8690
  • Fax: 815-229-8695
Mailing address:
  • Phone: 815-229-8690
  • Fax: 815-229-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010047
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036056126
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES DRAKE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 815-229-8690