Provider Demographics
NPI:1790838514
Name:BARRETT, JEFF B (PC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:B
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:B
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:747 E ETNA RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3777
Mailing Address - Country:US
Mailing Address - Phone:815-433-3308
Mailing Address - Fax:815-433-3744
Practice Address - Street 1:747 E ETNA RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3777
Practice Address - Country:US
Practice Address - Phone:815-433-3308
Practice Address - Fax:815-433-3744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
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
ILU36366Medicare UPIN
IL990630Medicare ID - Type Unspecified