Provider Demographics
NPI:1083910715
Name:BRAUCH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BRAUCH FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-848-4588
Mailing Address - Street 1:108 S WYNSTONE PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:N BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6923
Mailing Address - Country:US
Mailing Address - Phone:224-848-4588
Mailing Address - Fax:224-848-4585
Practice Address - Street 1:108 S WYNSTONE PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:N BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6923
Practice Address - Country:US
Practice Address - Phone:224-848-4588
Practice Address - Fax:224-848-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty