MEDICARE: DR. MARK E FREDRICK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038005092	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4915298	OTHER	IL	BCBS IL

General Provider Information

NPI Number	:	1467478404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E FREDRICK DC

Provider Business Mailing Address
First Line	:	3930 WEST WASHINGTON STREET
Second Line	:	STE B
City	:	GURNEE
State	:	IL
Zip	:	60031-5702
Country	:	US
Telephone Number	:	847-662-1600
Fax Number	:	847-662-1612

Provider Business Practice Location Address
First Line	:	3930 WEST WASHINGTON STREET
Second Line	:	STE B
City	:	GURNEE
State	:	IL
Zip	:	60031-5702
Country	:	US
Telephone Number	:	847-662-1600
Fax Number	:	847-662-1612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/06/2010

Similar Medicare Providers

1407941362 — DR. THOMAS BEZOUSKA DDS
Practice Location Address:

3930 WASHINGTON ST , SUITE A
GURNEE, IL
60031-5702

Practice Phone: 847-623-4888
Practice Fax: 847-623-0117

1831385434 — CHIROPRACTIC PLUS
Practice Location Address:

3930 WASHINGTON ST , SUITE B
GURNEE, IL
60031-5702

Practice Phone: 847-662-1600
Practice Fax: 847-662-1612

1275707390 — NORTH SHORE NAPRAPATHICS
Practice Location Address:

3930 WASHINGTON ST , SUITE B
GURNEE, IL
60031-5702

Practice Phone: 847-244-3536
Practice Fax:

1699445031 — GURNEECTD LLC
Practice Location Address:

3930 WASHINGTON ST
GURNEE, IL
60031-5702

Practice Phone: 847-623-4888
Practice Fax:

1508795287 — ALEXANDRA LOZA RBT
Practice Location Address:

105 N GREENLEAF ST STE B
GURNEE, IL
60031-3326

Practice Phone: 630-465-3963
Practice Fax:

1881523587 — KAITLYN DURAN BS
Practice Location Address:

105 N GREENLEAF ST STE B
GURNEE, IL
60031-3326

Practice Phone: 630-465-3963
Practice Fax:

Directions to “ DR. MARK E FREDRICK DC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.