Provider Demographics
NPI:1831385434
Name:CHIROPRACTIC PLUS
Entity type:Organization
Organization Name:CHIROPRACTIC PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-662-1600
Mailing Address - Street 1:3930 WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5702
Mailing Address - Country:US
Mailing Address - Phone:847-662-1600
Mailing Address - Fax:847-662-1612
Practice Address - Street 1:3930 WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5702
Practice Address - Country:US
Practice Address - Phone:847-662-1600
Practice Address - Fax:847-662-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0040143639OtherBCBS
IL0024940161OtherBCBS
IL4915298OtherBCBSIL
IL0024940161OtherBCBS
IL906310Medicare PIN