Provider Demographics
NPI:1134137961
Name:STOUGH, MARK T (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:STOUGH
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:FOUR TERRY DR THE ATRIUM
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-860-1181
Mailing Address - Fax:
Practice Address - Street 1:4 TERRY DR THE ATRIUM
Practice Address - Street 2:SUITE 18
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-860-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2581L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA062873Medicare ID - Type Unspecified