Provider Demographics
NPI:1275711319
Name:MARK R. COBLEIGH
Entity Type:Organization
Organization Name:MARK R. COBLEIGH
Other - Org Name:BELLEVUE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COBLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-734-6711
Mailing Address - Street 1:10403 S 15TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4448
Mailing Address - Country:US
Mailing Address - Phone:402-734-6711
Mailing Address - Fax:402-734-4162
Practice Address - Street 1:10403 S 15TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4448
Practice Address - Country:US
Practice Address - Phone:402-734-6711
Practice Address - Fax:402-734-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
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IA0991463OtherMEDICAID OF IOWA