Provider Demographics
NPI:1780666230
Name:DICKHOLTZ, MARSHALL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:DICKHOLTZ
Suffix:JR
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 1:2565 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6725
Mailing Address - Country:US
Mailing Address - Phone:847-272-1000
Mailing Address - Fax:847-272-9742
Practice Address - Street 1:2565 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6725
Practice Address - Country:US
Practice Address - Phone:847-272-1000
Practice Address - Fax:847-272-9742
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL662870Medicare PIN