Provider Demographics
NPI:1477529568
Name:LICHTENBERGER, BRIAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:LICHTENBERGER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BLAZE TRL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5508
Mailing Address - Country:US
Mailing Address - Phone:847-215-7096
Mailing Address - Fax:
Practice Address - Street 1:900 S ELMHURST RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5507
Practice Address - Country:US
Practice Address - Phone:847-718-7117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist