Healthcare Provider Details

I. General information

NPI: 1689216889
Provider Name (Legal Business Name): MARK LEVEE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 OAK STREET #1
NORTHFIELD IL
60093
US

IV. Provider business mailing address

1845 OAK STREET #1
NORTHFIELD IL
60093
US

V. Phone/Fax

Practice location:
  • Phone: 847-969-5376
  • Fax: 773-337-9106
Mailing address:
  • Phone: 312-880-9697
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: