Provider Demographics
NPI:1356326094
Name:PLETCHER, DANA Q (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:Q
Last Name:PLETCHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:Q
Other - Last Name:PLETCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:700 FLORSHEIM DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5000
Mailing Address - Country:US
Mailing Address - Phone:847-367-7131
Mailing Address - Fax:847-367-7482
Practice Address - Street 1:700 FLORSHEIM DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5000
Practice Address - Country:US
Practice Address - Phone:847-367-7131
Practice Address - Fax:847-367-7482
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14253Medicare ID - Type UnspecifiedMEDICARE #
IL210837Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILT37690Medicare UPIN