Individual
DR. BRIAN JAY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1010 LAKE ST STE 400, OAK PARK, IL 60301-1135
(708) 705-9494
(708) 221-7108
Mailing address
1010 LAKE ST STE 400, OAK PARK, IL 60301-1135
(708) 705-9494
(708) 221-7108
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
038010329
IL
Other
Enumeration date
06/13/2006
Last updated
12/11/2020
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