1275505091

Everything you always wanted to know about DR. RAFOOL E BRIAN DC but were afraid to ask.

DR. RAFOOL E BRIAN DC

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Provider Prefix Provider Last Name Provider Middle Name Provider First Name Provider Credential
DR. RAFOOL E BRIAN DC
Gender:
Male
Enumeration date:
2006-02-06
Last update date:
2007-12-13
Current as of:
2007-08-28
Is sole proprietor?:
No
Is organization subpart?:
Not Answered
In PECOS?:
Yes
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Identifiers

identifier description issuer state active
L03280 Medicare UPIN none IL 1

Taxonomies

Taxonomy State License Number Primary?
111N00000X Chiropractor IL none

Phone Numbers

Type Number
Mailing Address Telephone Number 3096926800
Practice Location Address Telephone Number 3096926800
Mailing Address Fax Number 3096924478
Practice Location Address Fax Number 3096924478

Addresses

Type Address City State Postal Country
Mailing Address 1524 W GLEN AVE PEORIA IL 61614 IL
Practice Location Address 1524 W GLEN AVE PEORIA IL 61614 IL

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1524 W GLEN AVE IL PEORIA
1588802623 BENNINGFIELD, JASON
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1962474791 WALKER, CHAD
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1524 W GLEN AVE IL PEORIA

Other NPI Records that share an identifier

NPI Name Address State City Identifier types that matches
1215940119 EASTSIDE WELLNESS CHIROPRACTIC
Organization
351 RUSCHE ST IL CREVE COEUR Identifier: L03280 (Medicare UPIN)