Provider Demographics
NPI:1114949641
Name:ABBOTT, MARK ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:ABBOTT
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 1:161 E OTTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2578
Mailing Address - Country:US
Mailing Address - Phone:724-836-5199
Mailing Address - Fax:724-836-5699
Practice Address - Street 1:161 E OTTERMAN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2578
Practice Address - Country:US
Practice Address - Phone:724-836-5199
Practice Address - Fax:724-836-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002780-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28834Medicare UPIN
PAAB113965Medicare ID - Type UnspecifiedMEDICARE #