Provider Demographics
NPI:1154463123
Name:WAMPFLER, DEEDEE M (DC)
Entity Type:Individual
Prefix:DR
First Name:DEEDEE
Middle Name:M
Last Name:WAMPFLER
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 1:1615 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-9126
Mailing Address - Country:US
Mailing Address - Phone:815-947-3320
Mailing Address - Fax:
Practice Address - Street 1:1615 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-9126
Practice Address - Country:US
Practice Address - Phone:815-947-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04928Medicare ID - Type UnspecifiedNON-PAR