Provider Demographics
NPI:1427308394
Name:MT PROSPECT MEDICAL SC
Entity type:Organization
Organization Name:MT PROSPECT MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OZTEKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-708-6600
Mailing Address - Street 1:301 E RAND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6089
Mailing Address - Country:US
Mailing Address - Phone:847-708-6600
Mailing Address - Fax:866-652-4523
Practice Address - Street 1:301 E RAND RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6089
Practice Address - Country:US
Practice Address - Phone:847-708-6600
Practice Address - Fax:866-652-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042620036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty