Provider Demographics
NPI:1568445971
Name:KORTAN, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KORTAN
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 1:2982 ANDRUS DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5211
Mailing Address - Country:US
Mailing Address - Phone:630-762-9427
Mailing Address - Fax:
Practice Address - Street 1:2103 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1310
Practice Address - Country:US
Practice Address - Phone:630-894-0550
Practice Address - Fax:630-894-0697
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL355410Medicare ID - Type Unspecified
ILU52077Medicare UPIN