MEDICARE: DR. DERRICK DREW POUSSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.013118	IL

General Provider Information

NPI Number	:	1144749151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK DREW POUSSON D.C.

Provider Business Mailing Address
First Line	:	5631 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4346
Country	:	US
Telephone Number	:	224-430-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	5631 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4346
Country	:	US
Telephone Number	:	224-430-3352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	06/02/2025

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