Provider Demographics
NPI:1356414593
Name:CECIL, BRIAN ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLAN
Last Name:CECIL
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 1:917C W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6613
Mailing Address - Country:US
Mailing Address - Phone:708-352-9393
Mailing Address - Fax:708-352-5077
Practice Address - Street 1:917C W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-6613
Practice Address - Country:US
Practice Address - Phone:708-352-9393
Practice Address - Fax:708-352-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16-82743OtherBCBSIL
IL207081Medicare ID - Type Unspecified
ILT38887Medicare UPIN