Provider Demographics
NPI:1235143413
Name:KOHN, MARK G (DC,)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:KOHN
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 1:3315 MAUCH CHUNK RD
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-2024
Mailing Address - Country:US
Mailing Address - Phone:610-769-7700
Mailing Address - Fax:610-769-4701
Practice Address - Street 1:3315 MAUCH CHUNK RD
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-2024
Practice Address - Country:US
Practice Address - Phone:610-769-7700
Practice Address - Fax:610-769-4701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006867-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02797200OtherCAPITAL BLUE CROSS
PAKO 1599274OtherHIGHMARK BLUE SHIELD
PA02797200OtherCAPITAL BLUE CROSS