Provider Demographics
NPI:1306859954
Name:GALE KERKHOFF, ANDREA KAE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:KAE
Last Name:GALE KERKHOFF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:KAE
Other - Last Name:GALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2826 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6340
Mailing Address - Country:US
Mailing Address - Phone:815-721-7470
Mailing Address - Fax:
Practice Address - Street 1:421 RIVER LN
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-5040
Practice Address - Country:US
Practice Address - Phone:815-633-7272
Practice Address - Fax:815-633-7274
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK30329Medicare ID - Type Unspecified