Provider Demographics
NPI:1548358443
Name:MOROVITZ, ROBERT KARL (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KARL
Last Name:MOROVITZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N MARKET ST
Mailing Address - Street 2:3A
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1077
Mailing Address - Country:US
Mailing Address - Phone:618-443-5357
Mailing Address - Fax:618-443-5357
Practice Address - Street 1:1505 N MARKET ST
Practice Address - Street 2:3A
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1077
Practice Address - Country:US
Practice Address - Phone:618-443-5357
Practice Address - Fax:618-443-5357
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0383128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207220OtherHEALTHLINK
IL7932003OtherBCBS
IL207220OtherHEALTHLINK
IL7932003OtherBCBS