Provider Demographics
NPI:1407903602
Name:MASHIKE, MARK M (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:MASHIKE
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 1:12750 CARMEL COUNTRY RD STE A111
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2159
Mailing Address - Country:US
Mailing Address - Phone:858-794-4007
Mailing Address - Fax:858-792-4004
Practice Address - Street 1:12750 CARMEL COUNTRY RD STE. A111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2159
Practice Address - Country:US
Practice Address - Phone:858-794-4007
Practice Address - Fax:858-792-4004
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25982111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30-0091274Medicare UPIN