Provider Demographics
NPI:1487648093
Name:OAS, MARK G (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:OAS
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 1:1740 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-4963
Mailing Address - Country:US
Mailing Address - Phone:715-552-7889
Mailing Address - Fax:715-552-7939
Practice Address - Street 1:1740 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-4963
Practice Address - Country:US
Practice Address - Phone:715-552-7889
Practice Address - Fax:715-552-7939
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3823-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38938900Medicaid
WI38938900Medicaid
WI000135747Medicare ID - Type Unspecified