Provider Demographics
NPI:1184638793
Name:KLEPZIG, BRIAN KEITH (DC, L AC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:KLEPZIG
Suffix:
Gender:M
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2950
Mailing Address - Country:US
Mailing Address - Phone:217-345-1416
Mailing Address - Fax:217-345-1460
Practice Address - Street 1:35 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2950
Practice Address - Country:US
Practice Address - Phone:217-345-1416
Practice Address - Fax:217-345-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038008290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL311370Medicare ID - Type Unspecified
ILU67377Medicare UPIN