1205059128 NPI number — DR. THOMAS D O'BRYAN D.C., C.C.N.

Table of content: DR. THOMAS D O'BRYAN D.C., C.C.N. (NPI 1205059128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205059128 NPI number — DR. THOMAS D O'BRYAN D.C., C.C.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRYAN
Provider First Name:
THOMAS
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., C.C.N.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205059128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 SHERIDAN SQ APT 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60202-4750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-733-1710
Provider Business Mailing Address Fax Number:
847-733-1711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28379 DAVIS PKWY
Provider Second Line Business Practice Location Address:
SUITE 801
Provider Business Practice Location Address City Name:
WARRENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60555-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-393-9800
Provider Business Practice Location Address Fax Number:
630-393-0499
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X , with the licence number:  0038-4472 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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