Provider Demographics
NPI:1073549556
Name:KRETSCHMAR, KEITH A (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:KRETSCHMAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 CARL SANDS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3112
Mailing Address - Country:US
Mailing Address - Phone:815-451-8331
Mailing Address - Fax:
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:815-451-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor