1134120900 NPI number — DR. DAWN REGINA GASKEY DC

Table of content: AMANDA LEE LILLEY-MACKAY MSP (NPI 1366875163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134120900 NPI number — DR. DAWN REGINA GASKEY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASKEY
Provider First Name:
DAWN
Provider Middle Name:
REGINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134120900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 COLONY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOMBARD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60148-4416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-776-6379
Provider Business Mailing Address Fax Number:
630-396-2240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
381 N YORK ST
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-478-9311
Provider Business Practice Location Address Fax Number:
630-396-2240
Provider Enumeration Date:
08/03/2005

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:  038-008719 , 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)

  • Identifier: 5477795 . This is a "FIRST HEALTH PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7916367 . This is a "AETNA PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2264221 . This is a "UHC PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4236188 . This is a "CIGNA PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02232247 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 646275 . This is a "ACN PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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