Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038-006950 | IL |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-006950 | IL |
NPI | 1033289335 |
---|---|
Provider Name | David W Flatt |
First Address | St Charles, IL 60174-5799 |
Second Address | St Charles, IL 60174-5799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038006950 | (05) | IL |
110174190 | RAILROAD MEDICARE (01) | IL |
4519993 | BLUE SHIELD (01) | IL |
920450 | MEDICARE PTAN (GROUP) (01) | IL |
920540022 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |
DB1658 | RAILROAD MEDICARE PTAN (GROUP) (01) | IL |
P01051865 | RAILROAD MEDICARE PTAN (INDIVIDUAL) (01) | IL |
U27121 | (02) |