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General NPI Number Information
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NPI Number | 1306203658
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Entity Type | Organization
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Legal Business Name | BRIGHTWATER & ASSOCIATES LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 1528 W MONROE ST
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City | CHICAGO
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State | IL
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Zip | 60607-2459
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Country | US
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Telephone | 630-335-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 1528 W MONROE ST
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City | CHICAGO
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State | IL
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Zip | 60607-2459
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Country | US
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Telephone | 630-335-3243
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FRANCIS KEATING
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Credential | D.O.
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Telephone | 630-335-3243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036124195
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License Number State | IL
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