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General NPI Number Information
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NPI Number | 1992531487
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Entity Type | Organization
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Legal Business Name | DR. BRIAN MCGUCKIN LABORATORY NUTRITION, PLLC
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 15 OAK ST STE 2A
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City | FRANKFORT
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State | IL
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Zip | 60423-1486
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Country | US
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Telephone | 779-324-5741
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Fax | 779-324-5607
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Provider Business Mailing Address
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Address Line | 21200 S LA GRANGE RD STE 189
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City | FRANKFORT
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State | IL
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Zip | 60423-2003
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Country | US
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Telephone | 779-324-5741
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Fax | 779-324-5607
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Authorized Official
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Title or Position | MANAGER OWNER OF PLLC
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Name | DR. BRIAN CHARLES MCGUCKIN
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Credential | DC
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Telephone | 779-324-5741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0900X
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Taxonomy Name | Internist Chiropractor
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License Number |
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License Number State |
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