Provider Demographics
NPI:1407081219
Name:CALEWARTS, DYLAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:CHRISTOPHER
Last Name:CALEWARTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3907
Mailing Address - Country:US
Mailing Address - Phone:847-345-0571
Mailing Address - Fax:
Practice Address - Street 1:503 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3907
Practice Address - Country:US
Practice Address - Phone:847-345-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor