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General NPI Number Information
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NPI Number | 1952739070
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Entity Type | Organization
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Legal Business Name | NICOLE BROD, D.C. LLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1121 WARREN AVE SUITE 270
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3570
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Country | US
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Telephone | 708-380-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 200 VILLAGE RD
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City | WILLOWBROOK
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State | IL
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Zip | 60527-6165
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Country | US
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Telephone | 708-380-0090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICOLE BROD
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Credential | D.C.
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Telephone | 708-380-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038.012491
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License Number State | IL
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