Provider Demographics
NPI:1821161605
Name:BRIM, JASON RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RANDALL
Last Name:BRIM
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 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:STE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-754-8792
Practice Address - Street 1:382 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3318
Practice Address - Country:US
Practice Address - Phone:224-856-2130
Practice Address - Fax:224-856-2131
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36181Medicare PIN
ILV11688Medicare UPIN