Provider Demographics
NPI:1477690683
Name:BRERETON, MARGARET DAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:DAVIS
Last Name:BRERETON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:DAVIS
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
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:
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:
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
IL0035640633OtherBLUE CROSS BLUE SHIELD
ILV05455Medicare UPIN
ILK18448Medicare ID - Type Unspecified