Provider Demographics
NPI:1144225889
Name:SHULMAN, MARK ALAN (MA, DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 QUERN CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4957
Mailing Address - Country:US
Mailing Address - Phone:410-363-8921
Mailing Address - Fax:410-363-0191
Practice Address - Street 1:7411 RIGGS RD
Practice Address - Street 2:STE 108
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-4246
Practice Address - Country:US
Practice Address - Phone:301-434-6932
Practice Address - Fax:301-434-0920
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1203PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT52533Medicare UPIN
MD490107Medicare ID - Type Unspecified