Provider Demographics
NPI:1326185877
Name:LOVE, MARK H (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:LOVE
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 127
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0127
Mailing Address - Country:US
Mailing Address - Phone:509-997-7062
Mailing Address - Fax:509-997-7022
Practice Address - Street 1:614 CANYON ROAD
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-7062
Practice Address - Fax:509-997-7022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000301823Medicare ID - Type Unspecified