Provider Demographics
NPI:1104845932
Name:DILL, JEFF WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:WAYNE
Last Name:DILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5082
Mailing Address - Country:US
Mailing Address - Phone:309-353-9700
Mailing Address - Fax:309-353-9701
Practice Address - Street 1:1340 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5082
Practice Address - Country:US
Practice Address - Phone:309-353-9700
Practice Address - Fax:309-353-9701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364195666OtherTAX ID
IL038007958OtherLICENSE NUMBER
IL038007958Medicaid
IL09021684OtherBLUE CROSS BLUE SHIELD ID