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General NPI Number Information
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NPI Number | 1386217768
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Entity Type | Individual
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Provider Name | BRODY SHARP DC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 2101 WAUKEGAN RD STE 100
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1836
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Country | US
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Telephone | 847-236-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 10 S DUNTON AVE APT 307
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-1485
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH13592
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013934
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License Number State | IL
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