Provider Demographics
NPI:1245206101
Name:GVIST, MARK ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:GVIST
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 1:204 S 1ST ST
Mailing Address - Street 2:BOX 133
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-7601
Mailing Address - Country:US
Mailing Address - Phone:515-989-0097
Mailing Address - Fax:515-989-9009
Practice Address - Street 1:204 S 1ST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-7601
Practice Address - Country:US
Practice Address - Phone:515-989-0097
Practice Address - Fax:515-989-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1258681Medicaid
IA1258681Medicaid
P65202Medicare UPIN