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1912696246
DYLAN JACOB SPENCER
WATERLOO, IL
NPI
1912696246
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225400000X Rehabilitation Practitioner
Enumeration Date
2023-05-03
Last Update Date
2023-05-03
Business Address
DYLAN JACOB SPENCER RSA
988 N ILLINOIS ROUTE 3
WATERLOO, IL 62298-1059
Phone number: 618-939-4444
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Mailing Address
DYLAN JACOB SPENCER RSA
PO BOX 146
WATERLOO, IL 62298-0146
Phone number: 618-939-4444
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