Provider Demographics
NPI:1750685046
Name:VAHLKAMP, DANIELLE (PHARMD, DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:VAHLKAMP
Suffix:
Gender:F
Credentials:PHARMD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62258-5052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3234
Practice Address - Country:US
Practice Address - Phone:618-532-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011845111N00000X, 111NS0005X
MO2019035654183500000X
IL051302298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician