Provider Demographics
NPI:1881868016
Name:BRANNICK CLINIC OF NATURAL MEDICINE, S.C.
Entity Type:Organization
Organization Name:BRANNICK CLINIC OF NATURAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:630-444-0066
Mailing Address - Street 1:1650 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2373
Mailing Address - Country:US
Mailing Address - Phone:630-444-0066
Mailing Address - Fax:630-444-1656
Practice Address - Street 1:1650 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2373
Practice Address - Country:US
Practice Address - Phone:630-444-0066
Practice Address - Fax:630-444-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty