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General NPI Number Information
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NPI Number | 1457477671
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Entity Type | Organization
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Legal Business Name | OAK CREEK HEALTHCARE, LTD
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 1526 CREEK DR
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City | MORRIS
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State | IL
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Zip | 60450-6862
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Country | US
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Telephone | 815-416-1132
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Fax | 815-416-1135
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Provider Business Mailing Address
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Address Line | 1526 CREEK DR
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City | MORRIS
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State | IL
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Zip | 60450-6862
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Country | US
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Telephone | 815-416-1132
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Fax | 815-416-1135
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MRS. ANDREA MARIE DEWASME
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Credential | D.C.
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Telephone | 815-416-1132
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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 | 042.618215
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License Number State | IL
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