Provider Demographics
NPI:1972746675
Name:BAZAN-PECHE, DELTON (DC)
Entity Type:Individual
Prefix:
First Name:DELTON
Middle Name:
Last Name:BAZAN-PECHE
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 1:2147 S FINLEY RD
Mailing Address - Street 2:APT# 1109
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6468
Mailing Address - Country:US
Mailing Address - Phone:630-390-9011
Mailing Address - Fax:847-352-0423
Practice Address - Street 1:3720 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3824
Practice Address - Country:US
Practice Address - Phone:773-277-2225
Practice Address - Fax:773-277-1134
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011288OtherILLINOIS DIV OF PROFESSIONAL REGULATION