Provider Demographics
NPI:1104833714
Name:MOHNAC, MARK VICTOR (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:VICTOR
Last Name:MOHNAC
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 1:2668 NORTH BELTLINE RD.
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-252-9595
Mailing Address - Fax:972-252-5579
Practice Address - Street 1:2668 NORTH BELTLINE RD.
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-252-9595
Practice Address - Fax:972-252-5579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6092111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU47633Medicare UPIN
TX604050Medicare ID - Type Unspecified