Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.012849 | IL |
N | 111NR0200X | Radiology | 038.012849 | IL |
N | 213ER0200X | Radiology | 038.012849 | IL |
NPI | 1689045916 |
---|---|
Provider Name | Dr. Brandon German |
First Address | Glen Ellyn, IL 60137-7800 |
Second Address | Glen Ellyn, IL 60137-7800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |