Provider Demographics
NPI:1093988016
Name:ATNIP, MARK E (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:ATNIP
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 1:2731 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3855
Mailing Address - Country:US
Mailing Address - Phone:270-444-7111
Mailing Address - Fax:270-444-7122
Practice Address - Street 1:2731 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3855
Practice Address - Country:US
Practice Address - Phone:270-444-7111
Practice Address - Fax:270-444-7122
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001402Medicaid
KYDB0778OtherRR MEDICARE GROUP
KY000000318314OtherANTHEM PIN
KYP00085622OtherRR MEDICARE
KY85900371OtherMEDICAID GROUP
KY0786101Medicare PIN
KYU84082Medicare UPIN
KY85001402Medicaid