Provider Demographics
NPI:1699218933
Name:BRICKER, JANA
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:BRICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1989
Mailing Address - Country:US
Mailing Address - Phone:847-989-7176
Mailing Address - Fax:
Practice Address - Street 1:514 N WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1989
Practice Address - Country:US
Practice Address - Phone:847-989-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherNONE