Provider Demographics
NPI:1477824290
Name:DRAKE, KATIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:M
Last Name:DRAKE
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 1:4105 HUMBERT RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-463-1600
Mailing Address - Fax:618-463-1624
Practice Address - Street 1:4105 HUMBERT RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-463-1600
Practice Address - Fax:618-463-1624
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012111111N00000X
IL038012111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor