Provider Demographics
NPI:1275675159
Name:PISARCZYK, MARK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:PISARCZYK
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:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0351
Mailing Address - Country:US
Mailing Address - Phone:413-589-0884
Mailing Address - Fax:413-589-0884
Practice Address - Street 1:563 CENTER ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2733
Practice Address - Country:US
Practice Address - Phone:413-589-0884
Practice Address - Fax:413-589-0884
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
6723704OtherCIGNA INSURANCE
MAPIY36238OtherBLUE CROSS BLUE SHIELD MA
CT050001490MA-02OtherBLUE CROSS BLUE SHIELD CT
T82058Medicare UPIN
MAPIY36238Medicare ID - Type Unspecified