Provider Demographics
NPI:1528244688
Name:O'BRIEN, BERNARD OWEN (DC)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:OWEN
Last Name:O'BRIEN
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 1:11259 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1803
Mailing Address - Country:US
Mailing Address - Phone:708-361-1400
Mailing Address - Fax:708-361-9490
Practice Address - Street 1:11259 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-1803
Practice Address - Country:US
Practice Address - Phone:708-361-1400
Practice Address - Fax:708-361-9490
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36378Medicare UPIN