Provider Demographics
NPI:1225384928
Name:DIRKX, CHRISTOPHER MOYLAN (PT DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MOYLAN
Last Name:DIRKX
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:M
Other - Last Name:DIRKX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:1850 SUNSET DR STE 102
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-1365
Practice Address - Country:US
Practice Address - Phone:515-953-1310
Practice Address - Fax:515-953-1322
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIN PROCESSMedicaid
IAIN PROCESSMedicare PIN