Individual
DYLAN JACOB SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1059
(618) 939-4444
Mailing address
PO BOX 146, WATERLOO, IL 62298-0146
(618) 939-4444
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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