Provider Demographics
NPI:1902133374
Name:MACNEIL, BRENDA (LAC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3320
Mailing Address - Country:US
Mailing Address - Phone:630-217-9000
Mailing Address - Fax:630-908-7651
Practice Address - Street 1:175 JACKSON AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5321
Practice Address - Country:US
Practice Address - Phone:630-313-2332
Practice Address - Fax:630-518-4883
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist