Provider Demographics
NPI:1689661985
Name:HOPPENRATH, DEAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ALLEN
Last Name:HOPPENRATH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1292
Mailing Address - Country:US
Mailing Address - Phone:815-412-1991
Mailing Address - Fax:
Practice Address - Street 1:309 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1292
Practice Address - Country:US
Practice Address - Phone:815-412-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU67549Medicare UPIN
ILK181124Medicare ID - Type Unspecified