Provider Demographics
NPI:1295013944
Name:MARK DIAZ D.C. P.C.
Entity Type:Organization
Organization Name:MARK DIAZ D.C. P.C.
Other - Org Name:ASH CREEK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-838-1951
Mailing Address - Street 1:226 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-2070
Mailing Address - Country:US
Mailing Address - Phone:503-838-1951
Mailing Address - Fax:503-606-2087
Practice Address - Street 1:226 S MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-2070
Practice Address - Country:US
Practice Address - Phone:503-838-1951
Practice Address - Fax:503-606-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245405893OtherINDIVIDUAL NPI