Individual
BRIAN G G BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9000 WAUKEGAN RD STE 100, MORTON GROVE, IL 60053-2128
(847) 779-6050
(847) 929-1167
Mailing address
9000 WAUKEGAN RD STE 100, MORTON GROVE, IL 60053-2128
(847) 779-6050
(847) 929-1167
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.003818
IL
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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