Individual
MR. MARK ALAN LACICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
206 WALNUT ST, HIGHLAND, IL 62249-2350
(618) 654-8989
(618) 654-8655
Mailing address
206 WALNUT ST, HIGHLAND, IL 62249-2350
(618) 654-8989
(618) 654-8655
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06032056
BLUE CROSS BLUE SHIELD
IL
01
—
539216
HEALTHLINK
IL
Enumeration date
01/28/2006
Last updated
07/08/2007
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