Provider Demographics
NPI:1790832053
Name:FRAHM, MARK RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RANDALL
Last Name:FRAHM
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 1:23 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9779
Mailing Address - Country:US
Mailing Address - Phone:630-364-8591
Mailing Address - Fax:
Practice Address - Street 1:888 S STATE ROUTE 59
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0962
Practice Address - Country:US
Practice Address - Phone:630-357-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
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
IL915921Medicare ID - Type Unspecified