Provider Demographics
NPI:1740273119
Name:BRETON, SHAWN M (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:BRETON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:M
Other - Last Name:BRETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PC
Mailing Address - Street 1:106 S EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3220
Mailing Address - Country:US
Mailing Address - Phone:847-368-1234
Mailing Address - Fax:847-603-7478
Practice Address - Street 1:106 S EMERSON ST
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3220
Practice Address - Country:US
Practice Address - Phone:847-368-1234
Practice Address - Fax:847-603-7478
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008779111N00000X
IL038.008779111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635079OtherBLUE CROSS BLUE SHIELD
U83917Medicare UPIN
ILK18137Medicare ID - Type Unspecified