Brian G G Bullock

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227.003818 Issued in IL

Practice address

9000 Waukegan Rd Ste 100
Morton Grove, IL 60053-2128

Phone

(847) 779-6050

Fax

(847) 929-1167

NPI assigned

Sep 16, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1407406002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 WAUKEGAN RD STE 100",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532128",
            "telephone_number": "847-779-6050",
            "fax_number": "847-929-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 WAUKEGAN RD STE 100",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532128",
            "telephone_number": "847-779-6050",
            "fax_number": "847-929-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "BRIAN G",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227.003818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Bbullock@ibji.com",
            "affiliation": "N",
            "endpointDescription": "GOOGLE DRIVE",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9000 Waukegan Rd Ste 100",
            "city": "Morton Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600532128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynn A Brown, PT
• Kelly Ann Browne, HIS
• Susan Broy, MD
• Kelcey Bruen, BCBA
• Daniela Buhai, PHARMD
• Jessica Bunyon
• Kaylie Burck, RBT
• Margaret Burnham
• Michael Burton Jr., MD
• Cindy Buss, RN

• Massage Therapist in Morton Grove, IL
• Providers in Morton Grove, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.