Provider Demographics
NPI:1225107709
Name:DRAKE, MARK ALAN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:DRAKE
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147
Mailing Address - Country:US
Mailing Address - Phone:614-861-0898
Mailing Address - Fax:614-861-0899
Practice Address - Street 1:1702 HILL RD. N.
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-861-0898
Practice Address - Fax:614-861-0899
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117171100000X
OH1904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2480686Medicaid
OH000000322345OtherBLUE CROSS AND BLUE SHIEL
OH9342111Medicare ID - Type Unspecified