| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1790723542 | JAK ENTERPRISES INC | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 | |||
| 1770580797 | HEDEN | JEFFREY | S | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 | |
| 1962608836 | PETERSON | LELAND | DAVID | 8309 N KNOXVILLE AVE | PEORIA | IL | 616152170 |