Provider Demographics
NPI:1417989575
Name:RICH, MARK E (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:RICH
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 1:29357 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3651
Mailing Address - Country:US
Mailing Address - Phone:419-666-5486
Mailing Address - Fax:
Practice Address - Street 1:23285 STATE ROUTE 51 W
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-1042
Practice Address - Country:US
Practice Address - Phone:419-855-7776
Practice Address - Fax:419-855-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1417989575OtherNPI
OH350033140Medicare ID - Type UnspecifiedMEDICARE RR
OHRI0614973Medicare ID - Type Unspecified
OHT48783Medicare UPIN