DEMITRIUS BRACKETT


Address: 350 E Washington St, Joliet, IL 60433-1150
Phone: 3123125791

DEMITRIUS BRACKETT (NPI# 1053911479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053911479
Entity Type Individual
Full Name DEMITRIUS BRACKETT
Practice Address 350 E Washington St
Joliet
IL 60433-1150
Practice Telephone 3123125791
Mailing Telephone 3123125791
Enumeration Date 2020-10-26
Last Update Date 2020-10-26
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QP3300X Clinic/Center
Specialization: Pain
Ambulatory Health Care Facilities

Office Location

Street Address 350 E WASHINGTON ST
City JOLIET
State IL
Zip Code 60433-1150

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NPI Name Taxonomy Address Enumeration
1245366483 Morningstar Counseling Counselor 350 E Washington St, Joliet, IL 60433-1150 2007-02-24

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1982176285 Anita Lomax Assistant Behavior Analyst 206 E Washington St Apt A, Joliet, IL 60433-1006 2018-12-26
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1215223755 Kodo Pharmacy Inc Durable Medical Equipment & Medical Supplies 1522 E Washington St, Joliet, IL 60433-1365 2011-06-23
1710175864 Brookelyn Anhalt Speech-Language Pathologist 2422 Erskine Rd, Joliet, IL 60433-1612 2007-10-12
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Taxonomy Information

Taxonomy Code 261QP3300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Pain

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
1790244150 Paradise Point Spa Clinic/Center 3207 Lake Ave Ste 13, Wilmette, IL 60091-1082 2019-03-15
1932610110 Julia Rackley Perry Memorial Hospital Clinic/Center 530 Park Ave E Fl 3, Princeton, IL 61356-3901 2017-10-16
1538606470 Naprapathy University Clinic/Center 320 E 21st St, Unit 405, Chicago, IL 60616-3190 2017-01-30
1306216403 Chicago Pain and Wellness Institute S.c. Clinic/Center 665 W North Ave, Suite 101, Lombard, IL 60148-1134 2015-10-01
1134597636 Great River Pain Clinic LLC Clinic/Center 555 N Kellogg St, Galesburg, IL 61401-3726 2015-09-14
1649651951 Wellness Institute of Illinois, Ltd. Clinic/Center 741 S Mchenry Ave Ste G, Crystal Lake, IL 60014-7445 2015-06-11
1558618512 Precision Diagnostics Clinic/Center 18623 81st Ave, Tinley Park, IL 60487-6279 2012-08-09
1962637157 Interventional Pain Medicine of Jacksonville, LLC Clinic/Center 1440 West Walnut Street, Jacksonville, IL 62650-0000 2009-05-18
1952565384 Aaa Headache and Pain Clinic Ltd Clinic/Center 1449 N Milwaukee Ave, Libertyville, IL 60048-1310 2008-07-15
1639332505 Interventional Pain Medicine LLC Clinic/Center 1 Bronze Pointe Blvd, Suite 1-a, Swansea, IL 62226-1045 2008-07-09
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Competitor

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City JOLIET
Zip Code 60433

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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