Healthcare Provider Details

I. General information

NPI: 1760458624
Provider Name (Legal Business Name): MARK J FREUND DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 E GRAND AVE LINDEN PLAZA
LINDENHURST IL
60046-9030
US

IV. Provider business mailing address

2118 E GRAND AVE LINDEN PLAZA
LINDENHURST IL
60046-9030
US

V. Phone/Fax

Practice location:
  • Phone: 847-265-0600
  • Fax: 847-265-0620
Mailing address:
  • Phone: 847-265-0600
  • Fax: 847-265-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: