1306859954 NPI number — DR. ANDREA KAE GALE KERKHOFF D.C.

Table of content: DR. ANDREA KAE GALE KERKHOFF D.C. (NPI 1306859954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306859954 NPI number — DR. ANDREA KAE GALE KERKHOFF D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALE KERKHOFF
Provider First Name:
ANDREA
Provider Middle Name:
KAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALE
Provider Other First Name:
ANDREA
Provider Other Middle Name:
KAE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306859954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2826 WOODHILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61114-6340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-721-7470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 RIVER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVES PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61111-5040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-633-7272
Provider Business Practice Location Address Fax Number:
815-633-7274
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038008655 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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