Provider Demographics
NPI:1295074664
Name:SUMMERKAMP SPINE & JOINT CENTER
Entity type:Organization
Organization Name:SUMMERKAMP SPINE & JOINT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUMMERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-858-4996
Mailing Address - Street 1:19212 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-8512
Mailing Address - Country:US
Mailing Address - Phone:815-742-0596
Mailing Address - Fax:815-455-5590
Practice Address - Street 1:4614 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6722
Practice Address - Country:US
Practice Address - Phone:224-858-4996
Practice Address - Fax:224-858-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty