Provider Demographics
NPI:1093872244
Name:MARK CINCOTTA CHIROPRACTIC
Entity Type:Organization
Organization Name:MARK CINCOTTA CHIROPRACTIC
Other - Org Name:SAN DIEGO CHIROPRACTIC DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CINCOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-444-3191
Mailing Address - Street 1:3691 VIA MERCADO
Mailing Address - Street 2:#15
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8301
Mailing Address - Country:US
Mailing Address - Phone:619-444-3191
Mailing Address - Fax:619-444-3193
Practice Address - Street 1:3691 VIA MERCADO
Practice Address - Street 2:#15
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8301
Practice Address - Country:US
Practice Address - Phone:619-444-3191
Practice Address - Fax:619-444-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC25964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25964Medicare ID - Type Unspecified