Healthcare Provider Details

I. General information

NPI: 1326179334
Provider Name (Legal Business Name): DENNIS L. DRAKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 S JACKSONVILLE ST
WHITE HALL IL
62092-1085
US

IV. Provider business mailing address

248 S JACKSONVILLE ST
WHITE HALL IL
62092-1085
US

V. Phone/Fax

Practice location:
  • Phone: 217-374-2369
  • Fax: 217-374-2369
Mailing address:
  • Phone: 217-374-2369
  • Fax: 217-374-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: