Provider Demographics
NPI:1689216889
Name:LEVEE, MARK (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LEVEE
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 1:1845 OAK STREET #1
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:312-880-9697
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:1845 OAK STREET #1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-969-5376
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038013404OtherIL STATE LICENSE