Provider Demographics
NPI:1487800447
Name:NEUBAUER, M. ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:ALAN
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:ALAN
Other - Last Name:NEUBAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:35865 N IL ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1907
Mailing Address - Country:US
Mailing Address - Phone:847-360-7170
Mailing Address - Fax:
Practice Address - Street 1:35865 N IL ROUTE 21
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1907
Practice Address - Country:US
Practice Address - Phone:847-360-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.005522111N00000X
MO005312111N00000X
ND466111N00000X
WI2152-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor