Provider Demographics
NPI:1407930878
Name:COBLEIGH, MARK RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:COBLEIGH
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 1:10403 S 15TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4448
Mailing Address - Country:US
Mailing Address - Phone:402-734-6711
Mailing Address - Fax:402-734-4162
Practice Address - Street 1:10403 S 15TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4448
Practice Address - Country:US
Practice Address - Phone:402-734-6711
Practice Address - Fax:402-734-4162
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0991463Medicaid
NE4561145OtherMIDLANDS CHOICE
NE4480052Medicaid
NE09618OtherBLUE CROSS BLUE SHIELD
NE470613526-13Medicaid
IA0991463Medicaid
NE09618OtherBLUE CROSS BLUE SHIELD
NE4561145OtherMIDLANDS CHOICE