Provider Demographics
NPI:1154447407
Name:ALLEN, BRIAN J (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-236-1194
Mailing Address - Fax:847-236-1195
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-236-1194
Practice Address - Fax:847-236-1195
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011163111N00000X
MDS03483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
204558300OtherMAMD
MD273638OtherAETNA
DCE466OtherBSDC
MD101022OtherJHHC
DD0972OtherMEDICARE RR
MD22281OtherALLIANCE
MDS765ALOtherBSMD
6978412004OtherASHN
204558300OtherMAMD