Provider Demographics
NPI:1427028133
Name:ILLINGSWORTH, THERESA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:RENEE
Last Name:ILLINGSWORTH
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 1:3267 RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5312
Mailing Address - Country:US
Mailing Address - Phone:563-332-2345
Mailing Address - Fax:563-332-1606
Practice Address - Street 1:3267 RIDGE PT
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5312
Practice Address - Country:US
Practice Address - Phone:563-332-2345
Practice Address - Fax:563-332-1606
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor