Provider Demographics
NPI:1609962638
Name:PAXTON, BRENT C (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:C
Last Name:PAXTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:847-872-8547
Practice Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - Street 2:2520 ELISHA AVENUE
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:847-872-8547
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04982069OtherBLUE CROSS BLUE SHIELD
IL780650Medicare ID - Type Unspecified