Healthcare Provider Details

I. General information

NPI: 1700723988
Provider Name (Legal Business Name): PHOENIX BX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 S KENWOOD AVE
CHICAGO IL
60619-3411
US

IV. Provider business mailing address

7938 S KENWOOD AVE
CHICAGO IL
60619-3411
US

V. Phone/Fax

Practice location:
  • Phone: 312-874-0715
  • Fax:
Mailing address:
  • Phone: 312-874-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR CHRISTIAN BROWN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 312-874-0715