MEDICARE: DR. BROOKLYN WASHINGTON DC

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	038012249	IL

General Provider Information

NPI Number	:	1790020477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKLYN WASHINGTON DC

Provider Business Mailing Address
First Line	:	16W343 83RD ST STE D
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-7950
Country	:	US
Telephone Number	:	630-908-7634
Fax Number	:

Provider Business Practice Location Address
First Line	:	16W343 83RD ST STE D
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-7950
Country	:	US
Telephone Number	:	630-908-7634
Fax Number	:

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	02/20/2020

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Directions to “ DR. BROOKLYN WASHINGTON DC” Practice Location

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