Provider Demographics
NPI:1174638670
Name:WILL, MARK T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:WILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKE COOK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4914
Mailing Address - Country:US
Mailing Address - Phone:847-945-3000
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD STE 105
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4914
Practice Address - Country:US
Practice Address - Phone:847-945-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4982087OtherBLUE CROSS/BLUE SHIELD
IL352101Medicare UPIN