Provider Demographics
NPI:1336245786
Name:TALBOT, DEREK LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LEWIS
Last Name:TALBOT
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 1:10 PHILLIP RD
Mailing Address - Street 2:STE 114
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1730
Mailing Address - Country:US
Mailing Address - Phone:847-573-1300
Mailing Address - Fax:847-247-1333
Practice Address - Street 1:10 PHILLIP RD
Practice Address - Street 2:STE 114
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-573-1300
Practice Address - Fax:847-247-1333
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932059OtherBCBS
IL209653Medicare ID - Type Unspecified
U85775Medicare UPIN