Provider Demographics
NPI:1376692996
Name:MEISTER, MARK ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:MEISTER
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 1:804 LIBERTY BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4643
Mailing Address - Country:US
Mailing Address - Phone:608-837-9114
Mailing Address - Fax:608-837-9521
Practice Address - Street 1:804 LIBERTY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4643
Practice Address - Country:US
Practice Address - Phone:608-837-9114
Practice Address - Fax:608-837-9521
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3274-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor