Provider Demographics
NPI:1760458624
Name:FREUND, MARK J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:FREUND
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 1:2118 E GRAND AVE
Mailing Address - Street 2:LINDEN PLAZA
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9030
Mailing Address - Country:US
Mailing Address - Phone:847-265-0600
Mailing Address - Fax:847-265-0620
Practice Address - Street 1:2118 E GRAND AVE
Practice Address - Street 2:LINDEN PLAZA
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9030
Practice Address - Country:US
Practice Address - Phone:847-265-0600
Practice Address - Fax:847-265-0620
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU61361Medicare UPIN
IL203951Medicare ID - Type Unspecified