Provider Demographics
NPI:1003252974
Name:PRATER, KALLI ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KALLI
Middle Name:ANN
Last Name:PRATER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1912
Mailing Address - Country:US
Mailing Address - Phone:630-762-9864
Mailing Address - Fax:
Practice Address - Street 1:113 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1912
Practice Address - Country:US
Practice Address - Phone:630-762-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012384111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist