Provider Demographics
NPI:1912071408
Name:TURK, FRED (DC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:TURK
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 1:5907 W 63RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638
Mailing Address - Country:US
Mailing Address - Phone:773-767-3719
Mailing Address - Fax:
Practice Address - Street 1:5907 W 63RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:773-767-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
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
IL0168221531OtherBCBS
IL0168221531OtherBCBS
IL200862Medicare ID - Type Unspecified