Provider Demographics
NPI:1992707970
Name:WEHREND, DARRELL (DC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:WEHREND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-323-2225
Mailing Address - Fax:630-323-5230
Practice Address - Street 1:777 OAKMONT LN
Practice Address - Street 2:SUITE 1000
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5511
Practice Address - Country:US
Practice Address - Phone:630-323-2225
Practice Address - Fax:630-323-5230
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-02-04
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
IL038-008598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17156Medicare PIN