Healthcare Provider Details

I. General information

NPI: 1619536927
Provider Name (Legal Business Name): DALE ANTHONY MRAZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N 129TH INFANTRY DR STE 101
JOLIET IL
60435-8347
US

IV. Provider business mailing address

823 N 129TH INFANTRY DR STE 101
JOLIET IL
60435-8347
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-3200
  • Fax: 815-741-8131
Mailing address:
  • Phone: 815-210-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: