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General NPI Number Information
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NPI Number | 1114577079
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Entity Type | Organization
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Legal Business Name | CAMP CHIROTHERAPY LLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 3925 W ALGONQUIN RD
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City | ALGONQUIN
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State | ID
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Zip | 60102
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Country | US
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Telephone | 224-325-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 2927 IMPRESSIONS DR
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-6700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. AMANDA ELIZABETH GERKE
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Credential | D.C.
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Telephone | 414-469-4193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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