Provider Demographics
NPI:1821392952
Name:KAESBERG, DILLON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DILLON
Middle Name:LEE
Last Name:KAESBERG
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 1:112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARISSA
Mailing Address - State:IL
Mailing Address - Zip Code:62257-1365
Mailing Address - Country:US
Mailing Address - Phone:618-295-2268
Mailing Address - Fax:618-295-3521
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARISSA
Practice Address - State:IL
Practice Address - Zip Code:62257-1365
Practice Address - Country:US
Practice Address - Phone:618-295-2268
Practice Address - Fax:618-295-3521
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor