Provider Demographics
NPI:1952434144
Name:BREWER, BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:BREWER
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 1:2800 N TALMAN AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7898
Mailing Address - Country:US
Mailing Address - Phone:630-430-8147
Mailing Address - Fax:773-478-7047
Practice Address - Street 1:2320 N DAMEN AVE
Practice Address - Street 2:SUITE 1R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3359
Practice Address - Country:US
Practice Address - Phone:773-489-0001
Practice Address - Fax:773-489-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636659OtherBLUE CROSS BLUE SHIELD