Provider Demographics
NPI:1558727123
Name:MK CHIROPRACTIC
Entity Type:Organization
Organization Name:MK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-291-8277
Mailing Address - Street 1:711 W NORTH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1042
Mailing Address - Country:US
Mailing Address - Phone:312-291-8277
Mailing Address - Fax:312-664-9181
Practice Address - Street 1:711 W NORTH AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1042
Practice Address - Country:US
Practice Address - Phone:312-291-8277
Practice Address - Fax:312-664-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty