Provider Demographics
NPI:1790889947
Name:BREITENSTEIN, LINDA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA SUE
Middle Name:
Last Name:BREITENSTEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N ADDISON AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-530-0506
Mailing Address - Fax:630-530-0854
Practice Address - Street 1:135 N ADDISON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-530-0506
Practice Address - Fax:630-530-0854
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
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
IL2232660OtherBCBS
IL5761484OtherCIGNA
IL5761484OtherCIGNA
IL211348Medicare ID - Type Unspecified