Provider Demographics
NPI:1467550947
Name:MORNINGSTAR, MARK W II (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:MORNINGSTAR
Suffix:II
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 1:8293 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-694-3576
Mailing Address - Fax:810-694-9544
Practice Address - Street 1:8293 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-694-3576
Practice Address - Fax:810-694-9544
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4446888Medicaid
MI4446888Medicaid
MIU93143Medicare UPIN