Provider Demographics
NPI:1457477671
Name:OAK CREEK HEALTHCARE, LTD
Entity Type:Organization
Organization Name:OAK CREEK HEALTHCARE, LTD
Other - Org Name:TWIN OAKS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEWASME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-416-1132
Mailing Address - Street 1:1526 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-6862
Mailing Address - Country:US
Mailing Address - Phone:815-416-1132
Mailing Address - Fax:815-416-1135
Practice Address - Street 1:1526 CREEK DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-6862
Practice Address - Country:US
Practice Address - Phone:815-416-1132
Practice Address - Fax:815-416-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.618215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3232011OtherBLUE CROSS BLUE SHIELD
IL3232011OtherBLUE CROSS BLUE SHIELD