Provider Demographics
NPI:1184642449
Name:BRAUCH, JENNIFER MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:BRAUCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 QUEENS CV
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4543
Mailing Address - Country:US
Mailing Address - Phone:847-387-3118
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010692111N00000X
NYX010249-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor