Provider Demographics
NPI:1073861688
Name:ELDRENKAMP, JOSHUA D (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:ELDRENKAMP
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-323-2225
Mailing Address - Fax:630-323-5230
Practice Address - Street 1:777 OAKMONT LN
Practice Address - Street 2:SUITE 1000
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5511
Practice Address - Country:US
Practice Address - Phone:630-323-2225
Practice Address - Fax:630-323-5230
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor