Provider Demographics
NPI:1346237203
Name:FORD, MARK ALLAN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:FORD
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 1:223 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 1ST AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3176
Practice Address - Country:US
Practice Address - Phone:641-673-7096
Practice Address - Fax:641-673-3848
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265660Medicaid
IA0424689Medicaid
IAI10310Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
IA1265660Medicaid
IAI10309Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER