Provider Demographics
NPI:1932744927
Name:RASSI, BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:RASSI
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 1:125 BEHRENDS CT
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2139
Mailing Address - Country:US
Mailing Address - Phone:309-360-6037
Mailing Address - Fax:
Practice Address - Street 1:387 OLD GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN HILLS
Practice Address - State:IL
Practice Address - Zip Code:61548-8679
Practice Address - Country:US
Practice Address - Phone:309-383-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor