Provider Demographics
NPI:1124213723
Name:SONNENBERG, MARK BYRON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BYRON
Last Name:SONNENBERG
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 1:1024 CHARLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1128
Mailing Address - Country:US
Mailing Address - Phone:314-277-3299
Mailing Address - Fax:
Practice Address - Street 1:1024 CHARLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1128
Practice Address - Country:US
Practice Address - Phone:314-277-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026612111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition