Provider Demographics
NPI:1376016931
Name:CHARRETTE, MARK N (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:N
Last Name:CHARRETTE
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 1:209 EDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7208
Mailing Address - Country:US
Mailing Address - Phone:972-890-4776
Mailing Address - Fax:
Practice Address - Street 1:500 FLOWER MOUND RD SPC 104
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3418
Practice Address - Country:US
Practice Address - Phone:972-890-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor