Provider Demographics
NPI:1679647325
Name:HILLARY, BRIAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:HILLARY
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 1:201 PARK PL STE 10
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1883
Mailing Address - Country:US
Mailing Address - Phone:815-939-2225
Mailing Address - Fax:815-939-8993
Practice Address - Street 1:201 PARK PL STE 10
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1883
Practice Address - Country:US
Practice Address - Phone:815-939-2225
Practice Address - Fax:815-939-8993
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAPPLIED FOROtherAPPLIED FOR
ILAPPLIED FORMedicare UPIN
ILAPPLIED FORMedicare ID - Type UnspecifiedAPPLIED FOR