Individual
DR. DAWN M SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
51 N MAIN ST, MANTENO, IL 60950-1534
(815) 468-8403
(815) 468-0154
Mailing address
51 N MAIN ST, MANTENO, IL 60950-1534
(815) 468-8403
(815) 468-0154
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4619978
BLUE CROSS PROVIDER #
IL
Enumeration date
10/04/2006
Last updated
07/09/2007
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