Provider Demographics
NPI:1548736796
Name:BRIGHTLIFE REGENERATIVE MEDICAL CLINIC SC
Entity Type:Organization
Organization Name:BRIGHTLIFE REGENERATIVE MEDICAL CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURLISON
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR (DC)
Authorized Official - Phone:847-680-9500
Mailing Address - Street 1:1580 S MILWAUKEE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3770
Mailing Address - Country:US
Mailing Address - Phone:847-680-9500
Mailing Address - Fax:
Practice Address - Street 1:1580 S MILWAUKEE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3770
Practice Address - Country:US
Practice Address - Phone:847-680-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty