Provider Demographics
NPI:1427209535
Name:DRAKE HEALTHCARE SC
Entity Type:Organization
Organization Name:DRAKE HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-229-8690
Mailing Address - Street 1:7264 ARGUS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5837
Mailing Address - Country:US
Mailing Address - Phone:815-229-8690
Mailing Address - Fax:815-229-8695
Practice Address - Street 1:7264 ARGUS DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5837
Practice Address - Country:US
Practice Address - Phone:815-229-8690
Practice Address - Fax:815-229-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010047111N00000X
IL036056126208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty