Provider Demographics
NPI:1881605517
Name:GREMMELS, ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:GREMMELS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:WELLNESS
Other - Middle Name:CARE
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1001 N CHENEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2705
Mailing Address - Country:US
Mailing Address - Phone:217-824-0404
Mailing Address - Fax:217-824-0404
Practice Address - Street 1:1001 N CHENEY ST STE B
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2705
Practice Address - Country:US
Practice Address - Phone:217-824-0404
Practice Address - Fax:217-824-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001132005OtherBLUE SHIELD
IL321545OtherHEALTHLINK
IL0001132005OtherBLUE SHIELD