MEDICARE: DR. MARK J FREUND 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	111NN1001X	Nutrition Chiropractor		IL

General Provider Information

NPI Number	:	1760458624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J FREUND DC

Provider Business Mailing Address
First Line	:	2118 E GRAND AVE
Second Line	:	LINDEN PLAZA
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-265-0600
Fax Number	:	847-265-0620

Provider Business Practice Location Address
First Line	:	2118 E GRAND AVE
Second Line	:	LINDEN PLAZA
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9030
Country	:	US
Telephone Number	:	847-265-0600
Fax Number	:	847-265-0620

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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