Provider Demographics
NPI:1407929573
Name:KATZ, MITCHELL A (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:KATZ
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 1:480 ELM PL
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2538
Mailing Address - Country:US
Mailing Address - Phone:847-266-7246
Mailing Address - Fax:847-266-7247
Practice Address - Street 1:480 ELM PL
Practice Address - Street 2:SUITE # 207
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2538
Practice Address - Country:US
Practice Address - Phone:847-266-7246
Practice Address - Fax:847-266-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4982073OtherBLUE CROSS BLUE SHIELD
IL4982073OtherBLUE CROSS BLUE SHIELD
ILT90822Medicare UPIN