Provider Demographics
NPI:1922174416
Name:BERNARD O OBRIEN DC PC
Entity Type:Organization
Organization Name:BERNARD O OBRIEN DC PC
Other - Org Name:OBRIEN CHIROPRACTIC HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-361-1400
Mailing Address - Street 1:11259 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482
Mailing Address - Country:US
Mailing Address - Phone:708-361-1400
Mailing Address - Fax:708-361-9490
Practice Address - Street 1:11259 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482
Practice Address - Country:US
Practice Address - Phone:708-361-1400
Practice Address - Fax:708-361-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634865OtherBLUE CROSS BLUE SHIELD
T36378Medicare UPIN
IL444830Medicare ID - Type Unspecified