Provider Demographics
NPI:1639530603
Name:DREYER, SIDNEY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:DREYER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S CANDLESTICK WAY
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-8670
Mailing Address - Country:US
Mailing Address - Phone:605-759-5373
Mailing Address - Fax:
Practice Address - Street 1:1920 FOOTBALL DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4829
Practice Address - Country:US
Practice Address - Phone:847-739-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960041522083S0010X
IL096.0041522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer