Provider Demographics
NPI:1235217795
Name:O'BRIEN, WILLIAM GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERARD
Last Name:O'BRIEN
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 1:309 BISHOP CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-2983
Mailing Address - Country:US
Mailing Address - Phone:630-246-2792
Mailing Address - Fax:
Practice Address - Street 1:320 E ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1757
Practice Address - Country:US
Practice Address - Phone:630-529-6111
Practice Address - Fax:630-529-6192
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206237Medicare ID - Type Unspecified