Provider Demographics
NPI:1437603206
Name:COHEN, MARK (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:COHEN
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 1:45200 STERRITT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5844
Mailing Address - Country:US
Mailing Address - Phone:586-739-6080
Mailing Address - Fax:586-739-2797
Practice Address - Street 1:45200 STERRITT ST STE 102
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5844
Practice Address - Country:US
Practice Address - Phone:586-739-6080
Practice Address - Fax:586-739-2797
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor