Provider Demographics
NPI:1154692127
Name:MENDOZA, BRIAN (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MENDOZA
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 1:275 N YORK ST
Mailing Address - Street 2:STE 301
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2784
Mailing Address - Country:US
Mailing Address - Phone:630-617-9790
Mailing Address - Fax:630-559-1023
Practice Address - Street 1:13657 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1936
Practice Address - Country:US
Practice Address - Phone:708-396-2500
Practice Address - Fax:708-396-8605
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor