Active NPI
Douglas Cort Drenckpohl, DCN, RD
- Pediatric Nutrition Registered Dietitian
- Peoria, IL
National Provider Identifier
1194526210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- 164002914
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637 - Phone
- (309) 624-0621
- Fax
- (309) 624-4291
- NPI assigned
- Mar 24, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 164002914 | IL | Primary |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637
Mailing address
1112 N. Underhill
Peoria, IL 61606
Phone (309) 253-7826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164002914 | IL | MD | Pediatric Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742774400000",
"number": "1194526210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 N. UNDERHILL",
"city": "PEORIA",
"state": "IL",
"postal_code": "61606",
"telephone_number": "309-253-7826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "61637",
"telephone_number": "309-624-0621",
"fax_number": "309-624-4291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRENCKPOHL",
"first_name": "DOUGLAS",
"middle_name": "CORT",
"name_prefix": "Dr.",
"credential": "DCN, RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-24",
"last_updated": "2025-03-24",
"certification_date": "2025-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "IL",
"license": "164002914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.