Provider Demographics
NPI:1699243675
Name:MOHR, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MOHR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N CANNONBALL TRL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IL
Mailing Address - Zip Code:60512-9770
Mailing Address - Country:US
Mailing Address - Phone:630-551-6440
Mailing Address - Fax:
Practice Address - Street 1:225 W HUBBARD ST STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4916
Practice Address - Country:US
Practice Address - Phone:773-906-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor