Provider Demographics
NPI:1467858050
Name:MICHAEL L BRECHON
Entity Type:Organization
Organization Name:MICHAEL L BRECHON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-544-2721
Mailing Address - Street 1:115 W LINCOLN AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3231
Mailing Address - Country:US
Mailing Address - Phone:815-544-2721
Mailing Address - Fax:815-544-3937
Practice Address - Street 1:115 W LINCOLN AVE
Practice Address - Street 2:SUITE1
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3231
Practice Address - Country:US
Practice Address - Phone:815-544-2721
Practice Address - Fax:815-544-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19016241335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier