Provider Demographics
NPI:1275523318
Name:SPERBECK, MARK JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JASON
Last Name:SPERBECK
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 1:40 N GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1765
Mailing Address - Country:US
Mailing Address - Phone:859-448-0900
Mailing Address - Fax:859-448-0989
Practice Address - Street 1:40 N GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1765
Practice Address - Country:US
Practice Address - Phone:859-448-0900
Practice Address - Fax:859-448-0989
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2422111N00000X
KY249709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00079393OtherRAILROAD MEDICARE
KY7100158890Medicaid
OH2046477Medicaid
OH2046477Medicaid
KY00653001Medicare PIN