Provider Demographics
NPI:1295838639
Name:WILK, MARK RAYMOND (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYMOND
Last Name:WILK
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:28 W 530 BATAVIA RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-393-3777
Mailing Address - Fax:630-393-3777
Practice Address - Street 1:28 W 530 BATAVIA RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-393-3777
Practice Address - Fax:630-393-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T27911Medicare UPIN
IL692700Medicare ID - Type Unspecified