Provider Demographics
NPI:1598843609
Name:DEAN, JULIE LYN (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYN
Last Name:DEAN
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:LYN
Other - Last Name:DEAN-MCCURDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, DICCP
Mailing Address - Street 1:3325 AVENUE OF THE CITIES
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4304
Mailing Address - Country:US
Mailing Address - Phone:309-757-8510
Mailing Address - Fax:309-757-8516
Practice Address - Street 1:3325 AVENUE OF THE CITIES
Practice Address - Street 2:SUITE B
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4304
Practice Address - Country:US
Practice Address - Phone:309-757-8510
Practice Address - Fax:309-757-8516
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL35-0051879OtherRAILROAD MEDICARE ID
IL8127241OtherBLUE SHIELD ID NUMBER
IL8127241OtherBLUE SHIELD ID NUMBER
IL701560Medicare ID - Type UnspecifiedMEDICARE ID NUMBER