Provider Demographics
NPI:1669557542
Name:BARRETT, MAXWELL (DC)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:BARRETT
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 1:633 SKOKIE BLVD
Mailing Address - Street 2:SUITE #270
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2858
Mailing Address - Country:US
Mailing Address - Phone:847-513-6996
Mailing Address - Fax:847-513-6998
Practice Address - Street 1:633 SKOKIE BLVD
Practice Address - Street 2:SUITE #270
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2858
Practice Address - Country:US
Practice Address - Phone:847-513-6996
Practice Address - Fax:847-513-6998
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK51006OtherMEDICARE ID TYPE UNSPECIFIED