Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DANE JACK CHURCH, MD
Active Sole ProprietorDANE JACK CHURCH, MD is a Sports Medicine (Orthopaedic) healthcare provider located in SPRINGFIELD, Illinois. NPI 1790128387 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (Orthopaedic) · SPRINGFIELD, IL
Registration Details
- NPI Number
- 1790128387
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 12, 2013 (13.385858109156 yrs)
- Last Updated
- Apr 13, 2020
- License
-
036148467 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1301 S KOKE MILL RDSPRINGFIELD, IL, 627119252Browse IL providers · Browse ZIP 62711
- Phone
- 2175479100
- Fax
- 2175479236
- Primary Specialty
-
Sports Medicine (Orthopaedic)
207XS0114X
Other Sports Medicine (Orthopaedic) Providers in SPRINGFIELD, IL
| Name | Credential | NPI |
|---|---|---|
| DR. PIERO CAPECCI | M.D. | 1154321222 |
| D GORDON ALLAN | MD | 1902892607 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.