Provider Demographics
NPI:1043260953
Name:SHERMAN, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:SHERMAN
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 1:172 BOONTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2948
Mailing Address - Country:US
Mailing Address - Phone:973-492-8811
Mailing Address - Fax:973-492-0411
Practice Address - Street 1:172 BOONTON AVE
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2948
Practice Address - Country:US
Practice Address - Phone:973-492-8811
Practice Address - Fax:973-492-0411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00384200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT90338Medicare UPIN
NJSH58516Medicare UPIN