Provider Demographics
NPI:1538125851
Name:DAILY-CAUL, JACKIE A (RD)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:A
Last Name:DAILY-CAUL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:A
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:581 KILKENNY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-8902
Mailing Address - Country:US
Mailing Address - Phone:847-888-3062
Mailing Address - Fax:
Practice Address - Street 1:77 N AIRLITE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-888-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN164-002449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04842Medicare ID - Type Unspecified