Provider Demographics
NPI:1386718559
Name:MERTES, DONALD L (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:MERTES
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 1:1350 S LORRAINE RD
Mailing Address - Street 2:APT A
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7076
Mailing Address - Country:US
Mailing Address - Phone:630-440-3392
Mailing Address - Fax:
Practice Address - Street 1:2811 S FAIRFIELD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1359
Practice Address - Country:US
Practice Address - Phone:630-537-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009169OtherLICENSE NUMBER
IL02215218OtherBCBS PROVIDER NUMBER
ILU88999Medicare UPIN