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General NPI Number Information
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NPI Number | 1295074664
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Entity Type | Organization
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Legal Business Name | SUMMERKAMP SPINE & JOINT CENTER
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 4614 W ALGONQUIN RD
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-6722
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Country | US
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Telephone | 224-858-4996
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Fax | 224-858-4072
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Provider Business Mailing Address
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Address Line | 19212 RIVER RD
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City | MARENGO
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State | IL
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Zip | 60152-8512
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Country | US
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Telephone | 815-742-0596
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Fax | 815-455-5590
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTIC PHYSICIAN
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Name | DR. DANIEL M SUMMERKAMP
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Credential | DC
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Telephone | 224-858-4996
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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 | 038011777
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License Number State | IL
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