Provider Demographics
NPI:1467487504
Name:FENTON, MARK AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AARON
Last Name:FENTON
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 1:11033 LA MAIDA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4521
Mailing Address - Country:US
Mailing Address - Phone:818-915-0886
Mailing Address - Fax:818-506-3633
Practice Address - Street 1:11033 LA MAIDA ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4521
Practice Address - Country:US
Practice Address - Phone:818-915-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0216820OtherBC/BS