Provider Demographics
NPI:1649363904
Name:COLEMAN, DARRON (DC)
Entity type:Individual
Prefix:DR
First Name:DARRON
Middle Name:
Last Name:COLEMAN
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 1:110 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1308
Mailing Address - Country:US
Mailing Address - Phone:708-343-7022
Mailing Address - Fax:708-343-7032
Practice Address - Street 1:110 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1308
Practice Address - Country:US
Practice Address - Phone:708-338-3446
Practice Address - Fax:708-343-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007496111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623158OtherBLUECROSS AND BLUESHIELD
IL038007496Medicaid