Healthcare Provider Details

I. General information

NPI: 1073793345
Provider Name (Legal Business Name): BRETON CHIROPRACTIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E RAND RD
ARLINGTON HEIGHTS IL
60004-4007
US

IV. Provider business mailing address

815 E RAND RD
ARLINGTON HEIGHTS IL
60004-4007
US

V. Phone/Fax

Practice location:
  • Phone: 847-368-1234
  • Fax: 847-603-7478
Mailing address:
  • Phone: 847-368-1234
  • Fax: 847-603-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038.009584
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038008779
License Number StateIL

VIII. Authorized Official

Name: DR. SHAWN M BRETON
Title or Position: PRESIDENT, CEO
Credential: DC DABCI
Phone: 847-368-1234