Provider Demographics
NPI:1174620975
Name:RICE, ROBERT BRANDON (BS, DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRANDON
Last Name:RICE
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 THOUVENOT LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-8917
Mailing Address - Country:US
Mailing Address - Phone:618-234-8300
Mailing Address - Fax:618-234-8295
Practice Address - Street 1:1207 THOUVENOT LN
Practice Address - Street 2:SUITE 100
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-8915
Practice Address - Country:US
Practice Address - Phone:618-234-8300
Practice Address - Fax:866-370-4183
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor