Provider Demographics
NPI:1710177589
Name:HIGHLAND PARK CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:HIGHLAND PARK CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL KATZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-266-7246
Mailing Address - Street 1:480 ELM PL
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2538
Mailing Address - Country:US
Mailing Address - Phone:847-266-7246
Mailing Address - Fax:
Practice Address - Street 1:480 ELM PL
Practice Address - Street 2:SUITE 207
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2538
Practice Address - Country:US
Practice Address - Phone:847-266-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006456111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4982073OtherBLUE CROSS BLUE SHIELD