1154447407 NPI number — MR. BRIAN J ALLEN D.C.

Table of content: MR. BRIAN J ALLEN D.C. (NPI 1154447407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154447407 NPI number — MR. BRIAN J ALLEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
BRIAN
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1154447407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 WAUKEGAN RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-236-1194
Provider Business Mailing Address Fax Number:
847-236-1195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-236-1194
Provider Business Practice Location Address Fax Number:
847-236-1195
Provider Enumeration Date:
03/21/2007

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: 111N00000X , with the licence number:  038011163 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: S03483 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 204558300 . This is a "MAMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 273638 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E466 . This is a "BSDC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 101022 . This is a "JHHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DD0972 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22281 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S765AL . This is a "BSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6978412004 . This is a "ASHN" identifier . This identifiers is of the category "OTHER".




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