Provider Demographics
NPI:1619536927
Name:MRAZ, DALE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ANTHONY
Last Name:MRAZ
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 1:823 N 129TH INFANTRY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8347
Mailing Address - Country:US
Mailing Address - Phone:815-210-1514
Mailing Address - Fax:
Practice Address - Street 1:823 N 129TH INFANTRY DR STE 101
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8347
Practice Address - Country:US
Practice Address - Phone:815-741-3200
Practice Address - Fax:815-741-8131
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor