Provider Demographics
NPI:1245333632
Name:VELASCO, MAURICE (DC)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:VELASCO
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-0177
Mailing Address - Country:US
Mailing Address - Phone:630-238-9345
Mailing Address - Fax:630-238-9344
Practice Address - Street 1:165 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106
Practice Address - Country:US
Practice Address - Phone:630-238-9345
Practice Address - Fax:630-238-9344
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02219455OtherBLUE CROSS BLUE SHIELD
IL038007228Medicaid
U42533Medicare UPIN
IL994831Medicare ID - Type Unspecified