Provider Demographics
NPI:1114024064
Name:FLEMING, DALE R (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:FLEMING
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540
Mailing Address - Country:US
Mailing Address - Phone:309-246-2663
Mailing Address - Fax:309-246-2664
Practice Address - Street 1:225 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540
Practice Address - Country:US
Practice Address - Phone:309-246-2663
Practice Address - Fax:309-246-2664
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6223015OtherBC BS
U68934Medicare UPIN
IL6223015OtherBC BS