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General NPI Number Information
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NPI Number | 1467858050
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Entity Type | Organization
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Legal Business Name | MICHAEL L BRECHON
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 115 W LINCOLN AVE SUITE1
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City | BELVIDERE
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State | IL
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Zip | 61008-3231
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Country | US
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Telephone | 815-544-2721
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Fax | 815-544-3937
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Provider Business Mailing Address
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Address Line | 115 W LINCOLN AVE SUITE1
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City | BELVIDERE
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State | IL
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Zip | 61008-3231
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Country | US
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Telephone | 815-544-2721
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Fax | 815-544-3937
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BRECHON
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Credential | DDS
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Telephone | 815-544-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 19016241
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License Number State | IL
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