Provider Demographics
NPI:1033172176
Name:HATESOHL, MARK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:HATESOHL
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 1:1213 HYLTON HEIGHTS RD
Mailing Address - Street 2:SUITE # 117
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2810
Mailing Address - Country:US
Mailing Address - Phone:785-537-8305
Mailing Address - Fax:785-537-2573
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:SUITE # 117
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2810
Practice Address - Country:US
Practice Address - Phone:785-537-8305
Practice Address - Fax:785-537-2573
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007496Medicare ID - Type Unspecified