Provider Demographics
NPI:1992531487
Name:DR. BRIAN MCGUCKIN LABORATORY NUTRITION, PLLC
Entity type:Organization
Organization Name:DR. BRIAN MCGUCKIN LABORATORY NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:779-324-5741
Mailing Address - Street 1:21200 S LA GRANGE RD STE 189
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2003
Mailing Address - Country:US
Mailing Address - Phone:779-324-5741
Mailing Address - Fax:779-324-5607
Practice Address - Street 1:15 OAK ST STE 2A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1486
Practice Address - Country:US
Practice Address - Phone:779-324-5741
Practice Address - Fax:779-324-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty