Provider Demographics
NPI:1053423533
Name:CATES, RAEGAN J (DC)
Entity type:Individual
Prefix:DR
First Name:RAEGAN
Middle Name:J
Last Name:CATES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RAEGAN
Other - Middle Name:J
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:315 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559
Mailing Address - Country:US
Mailing Address - Phone:630-968-6969
Mailing Address - Fax:630-968-8938
Practice Address - Street 1:315 W 63RD ST
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:630-968-6969
Practice Address - Fax:630-968-8938
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210791Medicare ID - Type Unspecified
V03370Medicare UPIN