Provider Demographics
NPI:1770629446
Name:BRERETON, CLIFTON SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:SAMUEL
Last Name:BRERETON
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 1:1455 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-854-4545
Mailing Address - Fax:847-854-4728
Practice Address - Street 1:1455 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-854-4545
Practice Address - Fax:847-854-4728
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0035640632OtherBLUE CROSS BLUE SHIELD
IL0035640632OtherBLUE CROSS BLUE SHIELD
ILV05454Medicare UPIN