Provider Demographics
NPI:1649787730
Name:MUNDELEIN CHIROPRACTIC DECOMPRESSION CENTER SERVICE CORPORATION
Entity type:Organization
Organization Name:MUNDELEIN CHIROPRACTIC DECOMPRESSION CENTER SERVICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUZEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-566-8777
Mailing Address - Street 1:355 E IL ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4250
Mailing Address - Country:US
Mailing Address - Phone:847-566-8777
Mailing Address - Fax:
Practice Address - Street 1:355 E IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4250
Practice Address - Country:US
Practice Address - Phone:847-566-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.004903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty