Search › Illinois › 103TB0200X
Demitrius Brackett, OWNER/DO
NPI 1053911479 · on the registry since 2020 · sole proprietor
Practice
- Address
- 411 N Bluff St Apt 11
Joliet, IL 60435 - Phone
- (815) 766-5999
- Organisation at this address
- Forevermore Mind Body & Soul
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 103TB0200X
103TB0200X
- Also registered as
- 372600000X
101YM0800X
174200000X - Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-01-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois