Healthcare Provider Details

I. General information

NPI: 1821161605
Provider Name (Legal Business Name): JASON RANDALL BRIM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 RANDALL RD
SOUTH ELGIN IL
60177-3318
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1234
US

V. Phone/Fax

Practice location:
  • Phone: 224-856-2130
  • Fax: 224-856-2131
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-754-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: