Provider Demographics
NPI:1235299074
Name:JAEHNIG, MARK CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHARLES
Last Name:JAEHNIG
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 1:110 BILLINGS RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2306
Mailing Address - Country:US
Mailing Address - Phone:617-773-4400
Mailing Address - Fax:617-773-0255
Practice Address - Street 1:110 BILLINGS RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2306
Practice Address - Country:US
Practice Address - Phone:617-773-4400
Practice Address - Fax:617-773-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA#744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7895158OtherCIGNA HEALTHCARE
MA651284OtherUNITED HEALTHCARE
MA352339OtherHARVARD PILGRIM
MA715146OtherTUFTS HEALTH
MA352339OtherHARVARD PILGRIM