Provider Demographics
NPI:1275088775
Name:NORTHSHOREATLAS, PC
Entity Type:Organization
Organization Name:NORTHSHOREATLAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-780-6068
Mailing Address - Street 1:1041 DAWES ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:847-362-8076
Practice Address - Street 1:3500 WESTERN AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1263
Practice Address - Country:US
Practice Address - Phone:847-780-6068
Practice Address - Fax:847-362-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty