Provider Demographics
NPI:1801973128
Name:TREHARNE, CYNTHIA DAWN (DC, PA)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DAWN
Last Name:TREHARNE
Suffix:
Gender:F
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-1718
Mailing Address - Country:US
Mailing Address - Phone:815-589-5255
Mailing Address - Fax:309-786-7980
Practice Address - Street 1:1106 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-1718
Practice Address - Country:US
Practice Address - Phone:815-589-5255
Practice Address - Fax:309-786-7980
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010663111N00000X
IL085001604363AM0700X
IA001363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02113Medicare PIN