1730166018 NPI number — DR. DENNY KOLKEBECK DPT

Table of content: DR. DENNY KOLKEBECK DPT (NPI 1730166018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730166018 NPI number — DR. DENNY KOLKEBECK DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLKEBECK
Provider First Name:
DENNY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

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:
1730166018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 SCENIC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115-6109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-761-7262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 BETHANY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60178-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-761-7262
Provider Business Practice Location Address Fax Number:
888-972-6580
Provider Enumeration Date:
12/28/2005

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: 225100000X , with the licence number:  070010239 , 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: 650018275 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com