Healthcare Provider Details

I. General information

NPI: 1154447407
Provider Name (Legal Business Name): BRIAN J ALLEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WAUKEGAN RD SUITE 100
BANNOCKBURN IL
60015-1836
US

IV. Provider business mailing address

2101 WAUKEGAN RD SUITE 100
BANNOCKBURN IL
60015-1836
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-1194
  • Fax: 847-236-1195
Mailing address:
  • Phone: 847-236-1194
  • Fax: 847-236-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011163
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03483
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: