Provider Demographics
NPI:1255319851
Name:KENDALL, MARK A (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KENDALL
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 1:1203 N COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2610
Mailing Address - Country:US
Mailing Address - Phone:248-363-1775
Mailing Address - Fax:248-363-3110
Practice Address - Street 1:1203 N COMMERCE RD
Practice Address - Street 2:BAY POINTE CHIROPRACTIC
Practice Address - City:COMMERCE
Practice Address - State:MI
Practice Address - Zip Code:48382-2610
Practice Address - Country:US
Practice Address - Phone:248-363-1775
Practice Address - Fax:248-363-3110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35005Medicare ID - Type Unspecified