Individual
KODY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1525 W LINCOLN HWY, DEKALB, IL 60115-3989
(815) 243-1824
Mailing address
1525 W LINCOLN HWY, DEKALB, IL 60115-3989
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003785
IL
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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