Healthcare Provider Details

I. General information

NPI: 1407929573
Provider Name (Legal Business Name): MITCHELL A KATZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 ELM PL SUITE # 207
HIGHLAND PARK IL
60035-2538
US

IV. Provider business mailing address

480 ELM PL SUITE # 207
HIGHLAND PARK IL
60035-2538
US

V. Phone/Fax

Practice location:
  • Phone: 847-266-7246
  • Fax: 847-266-7247
Mailing address:
  • Phone: 847-266-7246
  • Fax: 847-266-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: