Provider Demographics
NPI:1033289335
Name:FLATT, DAVID W (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:FLATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-208-3200
Mailing Address - Fax:630-208-3201
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-208-3200
Practice Address - Fax:630-208-3201
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006950111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110174190OtherRAILROAD MEDICARE
IL920540022OtherMEDICARE PTAN (INDIVIDUAL)
IL4519993OtherBLUE SHIELD
ILP01051865OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL038006950Medicaid
ILDB1658OtherRAILROAD MEDICARE PTAN (GROUP)
IL920450OtherMEDICARE PTAN (GROUP)
IL4519993OtherBLUE SHIELD
U27121Medicare UPIN