Provider Demographics
NPI:1083767727
Name:DRAKE, JAMES EDGAR WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDGAR WAYNE
Last Name:DRAKE
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 1:1860 S BELL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9372
Mailing Address - Country:US
Mailing Address - Phone:815-580-8270
Mailing Address - Fax:815-580-8278
Practice Address - Street 1:1860 S BELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61016-9372
Practice Address - Country:US
Practice Address - Phone:815-580-8270
Practice Address - Fax:815-580-8278
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010047111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation