=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285870477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN WEISSMAN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2008
-----------------------------------------------------
Last Update Date | 07/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1535 LAKE COOK RD SUITE 404
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-714-1531
-----------------------------------------------------
Fax | 841-714-1532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1535 LAKE COOK RD SUITE 404
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-714-1531
-----------------------------------------------------
Fax | 841-714-1532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-007634
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------