Provider Demographics
NPI:1508036500
Name:HIGHLAND CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HIGHLAND CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LACICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-654-8989
Mailing Address - Street 1:206 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1224
Mailing Address - Country:US
Mailing Address - Phone:618-654-8989
Mailing Address - Fax:618-654-8655
Practice Address - Street 1:206 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1224
Practice Address - Country:US
Practice Address - Phone:618-654-8989
Practice Address - Fax:618-654-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty