Mark E Fredrick, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038005092 Issued in IL

Practice address

3930 West Washington Street
Ste B
Gurnee, IL 60031-5702

Phone

(847) 662-1600

Fax

(847) 662-1612

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chiropractic Plus

  • Chiropractor
  • Gurnee, IL
  • NPI 1831385434
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286323200000",
    "number": "1467478404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 WEST WASHINGTON STREET",
            "address_2": "STE B",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315702",
            "telephone_number": "847-662-1600",
            "fax_number": "847-662-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 WEST WASHINGTON STREET",
            "address_2": "STE B",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315702",
            "telephone_number": "847-662-1600",
            "fax_number": "847-662-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "MARK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2010-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038005092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL",
            "identifier": "4915298",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel L. Foust, MA, LCPC, CADC
• Judith Fradin, LCSW
• Frank C Sun MD PC
• Gerald Allen Frank, MD
• Malcolm Fraser, PT
• Sarah Rose French-Villarreal
• Fresenius Medical Care Lake County, LLC
• Walter I Fried, PH.D., M.D.
• Lisa Lois Fuechtmann, LCPC
• Alyssa Fulton

• Chiropractor in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.