Provider Demographics
NPI:1013964998
Name:DEAKINS, ERIC C (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:DEAKINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:312-640-0407
Practice Address - Street 1:5230 S BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4106
Practice Address - Country:US
Practice Address - Phone:773-256-1475
Practice Address - Fax:773-256-1481
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008712A225100000X
IL070017505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000373723OtherANTHEM - 1ST AID PLUS
IN000000373726OtherANTHEM - APT PLUS
IN000000373702OtherANTHEM - MBWOUDE
IN214690RMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN214680RMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN000000373702OtherANTHEM - MBWOUDE
INP00259758Medicare ID - Type UnspecifiedRR MEDICARE