MEDICARE: DR. BRENT BREWER 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	038009882	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636659	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952434144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT BREWER D.C.

Provider Business Mailing Address
First Line	:	2800 N TALMAN AVE
Second Line	:	UNIT F
City	:	CHICAGO
State	:	IL
Zip	:	60618-7898
Country	:	US
Telephone Number	:	630-430-8147
Fax Number	:	773-478-7047

Provider Business Practice Location Address
First Line	:	2320 N DAMEN AVE
Second Line	:	SUITE 1R
City	:	CHICAGO
State	:	IL
Zip	:	60647-3359
Country	:	US
Telephone Number	:	773-489-0001
Fax Number	:	773-489-0003

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BRENT BREWER D.C.” Practice Location

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