Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1356438022 |
---|---|
Provider Name | Dr. Jeffrey Randall Cates |
First Address | Oregon, IL 61061-1304 |
Second Address | Oregon, IL 61061-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7182011 | BLUE CROSS / BLUE SHIELD (01) | IL |
T38373 | (02) | IL |