Provider Demographics
NPI:1710078886
Name:EZGUR, RICHARD MARC (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARC
Last Name:EZGUR
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 1:2835 N SHEFFIELD AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5084
Mailing Address - Country:US
Mailing Address - Phone:773-525-9355
Mailing Address - Fax:773-525-9397
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 411
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5084
Practice Address - Country:US
Practice Address - Phone:773-525-9355
Practice Address - Fax:773-525-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
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
IL0001607291OtherBLUE CROSS BLUE SHIELD #
IL389140Medicare ID - Type Unspecified
ILU61137Medicare UPIN