Provider Demographics
NPI:1932456720
Name:MUSIAL, BRIAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:MUSIAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CHAMBERLAIN LN
Mailing Address - Street 2:UNIT 208
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9285
Mailing Address - Country:US
Mailing Address - Phone:708-297-5624
Mailing Address - Fax:
Practice Address - Street 1:445 JACKSON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5256
Practice Address - Country:US
Practice Address - Phone:630-699-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist